Active NPI
Julee K. Richards, M.D.
- Dermatology Physician
- Roseburg, OR
National Provider Identifier
1467475137
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- MD17078
- Practice address
- 341 Medical Loop Ste 110
Roseburg, OR 97471-5546 - Phone
- (541) 440-2165
- Fax
- (541) 440-8932
- NPI assigned
- Jul 25, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | MD17078 | OR | Primary |
Addresses
Primary practice location
341 Medical Loop Ste 110
Roseburg, OR 97471-5546
Mailing address
341 Medical Loop Ste 110
Roseburg, OR 97471-5546
Phone (541) 440-2165
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 804708001 | Other | OR | BLUE CROSS |
| R112608 | Other | OR | MEDICARE GROUP PIN |
| 070016168 | Other | OR | RR MEDICARE PIN |
| CJ9890 | Other | OR | RR MEDICARE GROUP PIN |
| 026463 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040331000486 | OR | Practitioner - Dermatology | 0345130019 | Reassigns benefits to 1 organization |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mountain West Derm - Blackhart PLLC | Dermatology | Current | Accepting new patients |
| Bend Dermatology Clinic LLC | Dermatology | Current | Accepting new patients |
| Mountain West Derm - Blackhart PLLC | Dermatology | Current | Accepting new patients |
| Mountain West Derm-Blackhart, PLLC | Dermatology | Current | Accepting new patients |
Locations
2747 NE Conners Ave
Bend, OR 97701
Phone (541) 322-1980
341 NW Medical Loop
Ste 110
Roseburg, OR 97471
Phone (541) 440-2165
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153785600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1215561600000",
"number": "1467475137",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "341 MEDICAL LOOP STE 110",
"city": "ROSEBURG",
"state": "OR",
"postal_code": "974715546",
"telephone_number": "541-440-2165",
"fax_number": "541-440-8932"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "341 MEDICAL LOOP STE 110",
"city": "ROSEBURG",
"state": "OR",
"postal_code": "974715546",
"telephone_number": "541-440-2165",
"fax_number": "541-440-8932"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RICHARDS",
"first_name": "JULEE",
"middle_name": "K.",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-25",
"last_updated": "2008-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "OR",
"license": "MD17078",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "804708001",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE GROUP PIN",
"identifier": "R112608",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE PIN",
"identifier": "070016168",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE GROUP PIN",
"identifier": "CJ9890",
"state": "OR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "026463",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Roseburg, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.