Active NPI
Edmund Gary Servais, MD
- Ophthalmology Physician
- Salem, OR
National Provider Identifier
1477627735
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- 17998
- Practice address
- 2450 12TH Street SE
Salem, OR 97302 - Phone
- (503) 371-4350
- Fax
- (503) 371-1124
- NPI assigned
- Nov 20, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | 17998 | OR | Primary |
Addresses
Primary practice location
2450 12TH Street SE
Salem, OR 97302
Mailing address
2450 12TH Street SE
Salem, OR 97302
Phone (503) 371-4350
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 055504 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17998 | OR | MD | Ophthalmology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Teplick Laser Surgery Centers | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Specialist
- Beaverton, OR
- NPI 1851421085
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163980800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1477627735",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2450 12TH STREET SE",
"city": "SALEM",
"state": "OR",
"postal_code": "97302",
"telephone_number": "503-371-4350",
"fax_number": "503-371-1124"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2450 12TH STREET SE",
"city": "SALEM",
"state": "OR",
"postal_code": "97302",
"telephone_number": "503-371-4350",
"fax_number": "503-371-1124"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SERVAIS",
"first_name": "EDMUND",
"middle_name": "GARY",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "OR",
"license": "17998",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "055504",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Salem, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.