NPIMap

Organization Active NPI

Northwest Medical Specialist LLC

Doing business as NW Brain and Spine

  • Neurological Surgery Physician
  • Bend, OR
National Provider Identifier
1588674279
Registry record updated Apr 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
Legal business name
NORTHWEST MEDICAL SPECIALIST LLC
Doing business as
NW Brain and Spine
Practice address
2115 NE Wyatt CT
Suite #201
Bend, OR 97701-7678
Phone
(541) 585-2400
Fax
(541) 585-2407
NPI assigned
Aug 8, 2006
Last updated
Apr 9, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2019

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

Authorized official

Name
Dr. Kent Yundt, MDNPI 1275518797
Title
Medical Director
Phone
(541) 585-2400

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207T00000X Primary
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

Primary practice location

2115 NE Wyatt CT
Suite #201
Bend, OR 97701-7678

Mailing address

2115 NE Wyatt CT
Suite #201
Bend, OR 97701-7678
Phone (541) 585-2400

Other names 1

  • NW Brain and Spine Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041008000861 OR Part B Supplier - Clinic/Group Practice 3971562414 Receives reassigned benefits from 11 practitioners
Practice locations: Bend, OR

National Provider Directory

National Provider Directory

Locations

2115 NE Wyatt Ct
Ste 201
Bend, OR 97701
Phone (541) 610-7246

470 NE A St
Madras, OR 97741
Phone (541) 475-3882

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1154995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1554768000000",
    "number": "1588674279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2115 NE WYATT CT",
            "address_2": "SUITE #201",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977017678",
            "telephone_number": "541-585-2400",
            "fax_number": "541-585-2407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2115 NE WYATT CT",
            "address_2": "SUITE #201",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977017678",
            "telephone_number": "541-585-2400",
            "fax_number": "541-585-2407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST MEDICAL SPECIALIST LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-08",
        "last_updated": "2019-04-09",
        "status": "A",
        "authorized_official_last_name": "YUNDT",
        "authorized_official_first_name": "KENT",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "541-585-2400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Neurological Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NW Brain and Spine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "NW Brain and Spine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bend, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.