Bend Dermatology Clinic LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

38D0628271 Issued in OR

Legal business name

BEND DERMATOLOGY CLINIC LLC

Doing business as

Cascadia Histopathology

Practice address

2705 NE Conners Ave
Bend, OR 97701-6904

Phone

(541) 382-5712

Fax

(541) 382-2605

NPI assigned

Oct 14, 2008

Organization subpart

Yes

Parent organization

BEND DERMATOLOGY CLINIC LLCAs reported in NPPES

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

Authorized official

Name

Mrs. Suzanne R Maitland

Title

Administrator

Phone

(541) 322-1980

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Cascadia Histopathology Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Part of

Bend Dermatology Clinic LLC

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Bend Dermatology Clinic LLC

  • Dermatology Physician
  • Bend, OR
  • NPI 1649244393
  NPPES parent name

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

{
    "created_epoch": "1223942400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1337126400000",
    "number": "1548412224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2747 NE CONNERS AVE",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977018738",
            "telephone_number": "541-382-5712",
            "fax_number": "541-382-2605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2705 NE CONNERS AVE",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977016904",
            "telephone_number": "541-382-5712",
            "fax_number": "541-382-2605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEND DERMATOLOGY CLINIC LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BEND DERMATOLOGY CLINIC LLC",
        "enumeration_date": "2008-10-14",
        "last_updated": "2012-05-16",
        "status": "A",
        "authorized_official_last_name": "MAITLAND",
        "authorized_official_first_name": "SUZANNE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "541-322-1980",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "OR",
            "license": "38D0628271",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE PTAN",
            "identifier": "P00692242",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cascadia Histopathology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Clinical Medical Laboratory in Bend, OR
• Providers in Bend, OR by specialty
• Clinical Medical Laboratory in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.