NPIMap

Organization Active NPI

Gastroenterology Consultants, PC

  • Gastroenterology Physician
  • Medford, OR
National Provider Identifier
1639104136
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
07-00021219 Issued in OR
Legal business name
GASTROENTEROLOGY CONSULTANTS, PC
Practice address
2860 Creekside Cir
Medford, OR 97504-8442
Phone
(541) 779-8367
Fax
(541) 779-7471
NPI assigned
Jul 12, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Debbie J Nielsen
Title
Office Manager
Phone
(541) 779-8367

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RG0100X 07-00021219 OR Primary

Addresses

Primary practice location

2860 Creekside Cir
Medford, OR 97504-8442

Mailing address

2860 Creekside Cir
Medford, OR 97504-8442
Phone (541) 779-8367

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040426000248 OR Part B Supplier - Clinic/Group Practice 4789670506 Receives reassigned benefits from 14 practitioners
Practice locations: Medford, OR

National Provider Directory

National Provider Directory

Locations

2860 Creekside Cir
Medford, OR 97504
Phone (541) 779-8367

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1639104136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2860 CREEKSIDE CIR",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975048442",
            "telephone_number": "541-779-8367",
            "fax_number": "541-779-7471"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2860 CREEKSIDE CIR",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975048442",
            "telephone_number": "541-779-8367",
            "fax_number": "541-779-7471"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GASTROENTEROLOGY CONSULTANTS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "NIELSEN",
        "authorized_official_first_name": "DEBBIE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "541-779-8367",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "OR",
            "license": "07-00021219",
            "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 Aug 22, 2020; 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.