Active NPI
Dennis M. Bruneau, PA-C
- Physician Assistant
- Christmas Valley, OR
National Provider Identifier
1497810915
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA00217
- Practice address
- 87520 Bay Rd
Christmas Valley, OR 97641-0377 - Phone
- (541) 576-2343
- Fax
- (541) 576-2869
- NPI assigned
- Dec 26, 2006
- Last updated
- Oct 15, 2015
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA00217 | OR | Primary |
Addresses
Primary practice location
87520 Bay Rd
Christmas Valley, OR 97641-0377
Mailing address
PO Box 3300
La Pine, OR 97739-3300
Phone (541) 576-2343
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 970003593 | Other | MEDICARE RAILROAD | |
| 182817 | 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
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA00217 | OR | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bruce D. Carlson | Past | Accepting new patients | |
| North Lake Clinic, LLC | Past | Accepting new patients | |
| Bruce D Carlson M.D. | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Rural Health Clinic/Center
- Christmas Valley, OR
- NPI 1851456305
-
dba Gilliam County Medical Center
- Rural Health Clinic/Center
- Condon, OR
- NPI 1376608901
-
- Rural Health Clinic/Center
- Christmas Valley, OR
- NPI 1669607792
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167091200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1444867200000",
"number": "1497810915",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3300",
"city": "LA PINE",
"state": "OR",
"postal_code": "977393300",
"telephone_number": "541-576-2343",
"fax_number": "541-576-2869"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "87520 BAY RD",
"city": "CHRISTMAS VALLEY",
"state": "OR",
"postal_code": "976410377",
"telephone_number": "541-576-2343",
"fax_number": "541-576-2869"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRUNEAU",
"first_name": "DENNIS",
"middle_name": "M.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-26",
"last_updated": "2015-10-15",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "OR",
"license": "PA00217",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAILROAD",
"identifier": "970003593",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "182817",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Christmas Valley, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.