Jessica R Carlson, M.D.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

MD176604 Issued in OR

Practice address

94220 4TH St
Gold Beach, OR 97444-7756

Phone

(541) 247-3910

Fax

(541) 247-3109

NPI assigned

Jun 20, 2011

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Curry Health District

  • Critical Access Hospital
  • Gold Beach, OR
  • NPI 1487696985
  Medicare reassignment NPD
• Curry Health District

  • Rural Health Clinic/Center
  • Gold Beach, OR
  • NPI 1770303968
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1308528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600214400000",
    "number": "1487940318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "94220 4TH ST",
            "city": "GOLD BEACH",
            "state": "OR",
            "postal_code": "974447756",
            "telephone_number": "541-247-3000",
            "fax_number": "541-247-3104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "94220 4TH ST",
            "city": "GOLD BEACH",
            "state": "OR",
            "postal_code": "974447756",
            "telephone_number": "541-247-3910",
            "fax_number": "541-247-3109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARLSON",
        "first_name": "JESSICA",
        "middle_name": "R",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-20",
        "last_updated": "2020-09-16",
        "certification_date": "2020-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "OR",
            "license": "MD176604",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CURRY GENERAL HOSPITAL NPI",
            "identifier": "1487696985",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500706467",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cornelius L Britt, M.D.
• Brookings Counseling Center PC
• Marci Brose
• Cal-Ore Life Flight LLC
• Cal-Ore Life Flight LLC
• Emily Nicole Caruso, DMD
• Gerald Cavanagh, PHARMD
• Central Curry School District #1
• Mary Chambers, CADCI
• Kathryn Chassereau, L.M.T.

• Surgery Physician in Gold Beach, OR
• Providers in Gold Beach, OR by specialty
• Surgery Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2020; 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.

Verify at the official NPI Registry.