Active NPI
Misty Camacho, RDH
- Dental Hygienist
- Medford, OR
National Provider Identifier
1588095053
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- H6658
- Practice address
- 1113 Progress Dr
Medford, OR 97504-5201 - Phone
- (541) 512-3900
- Fax
- (541) 414-1175
- NPI assigned
- Dec 9, 2013
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | H6658 | OR | Primary |
Addresses
Primary practice location
1113 Progress Dr
Medford, OR 97504-5201
Mailing address
931 Chevy Way
Medford, OR 97504-4127
Phone (541) 690-3555
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| H6658 | OR | MD | Dental Hygienist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| La Clinica del Valle Family Health Care Center Inc. | 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.
-
- Federally Qualified Health Center (FQHC)
- Medford, OR
- NPI 1891061784
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1386547200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1600992000000",
"number": "1588095053",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "931 CHEVY WAY",
"city": "MEDFORD",
"state": "OR",
"postal_code": "975044127",
"telephone_number": "541-690-3555",
"fax_number": "541-842-2212"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1113 PROGRESS DR",
"city": "MEDFORD",
"state": "OR",
"postal_code": "975045201",
"telephone_number": "541-512-3900",
"fax_number": "541-414-1175"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CAMACHO",
"first_name": "MISTY",
"credential": "RDH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-12-09",
"last_updated": "2020-09-25",
"certification_date": "2020-09-25",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "OR",
"license": "H6658",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Medford, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.