Individual provider Active NPI

Stephen Andrew McIlmoil, D.O.

  • Emergency Medical Services (Emergency Medicine) Physician
  • La Grande, OR
National Provider Identifier
1598052813
Registry record updated Aug 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medical Services (Emergency Medicine) PhysicianTaxonomy code 207PE0004X
License
DO166905 Issued in OR
Practice address
900 Sunset Dr
La Grande, OR 97850-1387
Phone
(541) 963-8421
Fax
(541) 963-1476
NPI assigned
Jul 7, 2011
Last updated
Aug 14, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medical Services (Emergency Medicine) Physician 207PE0004X 5101019465 MI
Emergency Medical Services (Emergency Medicine) Physician 207PE0004X DO166905 OR Primary

Addresses

Primary practice location

900 Sunset Dr
La Grande, OR 97850-1387

Mailing address

PO Box 3290
La Grande, OR 97850-7290
Phone (541) 963-8421

Other identifiers 1

IdentifierTypeStateIssuer
500674427MedicaidOR

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20140910001419 OR Practitioner - Emergency Medicine 9739308594 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Western University of Health Sciences College of Dental Med, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Grande Ronde Hospital IncGroup PAC ID 0547170789, 97 clinicians

Practice addresses (Care Compare)

900 Sunset Dr
La Grande, OR 97850-1387
Phone (541) 963-8421

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
5101019465MIMDEmergency Medical Services (Emergency Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Grande Ronde Hospital, Inc. CurrentSince Jul 13, 2014 Accepting new patients
Grande Ronde Hospital, Inc. CurrentSince Jul 13, 2014 Accepting new patients

Locations

900 Sunset Dr
La Grande, OR 97850
Phone (541) 963-8421

Organizations & group practices 2

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1309996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597363200000",
    "number": "1598052813",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3290",
            "city": "LA GRANDE",
            "state": "OR",
            "postal_code": "978507290",
            "telephone_number": "541-963-8421",
            "fax_number": "541-963-1476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 SUNSET DR",
            "city": "LA GRANDE",
            "state": "OR",
            "postal_code": "978501387",
            "telephone_number": "541-963-8421",
            "fax_number": "541-963-1476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCILMOIL",
        "first_name": "STEPHEN",
        "middle_name": "ANDREW",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-07-07",
        "last_updated": "2020-08-14",
        "certification_date": "2020-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "MI",
            "license": "5101019465",
            "primary": false
        },
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "OR",
            "license": "DO166905",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500674427",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in La Grande, OR

Sources for this page

Verify at the official NPI Registry.