NPIMap

Organization Active NPI

Bend Dermatology Clinic LLC

  • Dermatology Physician
  • Bend, OR
National Provider Identifier
1649244393
Registry record updated Jun 17, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
BEND DERMATOLOGY CLINIC LLC
Practice address
2747 NE Conners Ave
Bend, OR 97701-8738
Phone
(541) 382-5712
Fax
(541) 382-2605
NPI assigned
Feb 16, 2006
Last updated
Jun 17, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2010

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

Authorized official

Name
Suzanne Maitland
Title
Office Manager
Phone
(541) 382-5712

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X NU Primary

Addresses

Primary practice location

2747 NE Conners Ave
Bend, OR 97701-8738

Mailing address

2747 NE Conners Ave
Bend, OR 97701-8738
Phone (541) 382-5712

Other identifiers 1

IdentifierTypeStateIssuer
286941MedicaidOR

National Provider Directory

National Provider Directory

Locations

2855 NW Crossing Dr
Ste 103
Bend, OR 97703

413 NW Larch Ave
Ste 202
Redmond, OR 97756

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 32

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.

View all 32

NPI Registry JSON

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

{
    "created_epoch": "1140048000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1276732800000",
    "number": "1649244393",
    "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": "2747 NE CONNERS AVE",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977018738",
            "telephone_number": "541-382-5712",
            "fax_number": "541-382-2605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEND DERMATOLOGY CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-16",
        "last_updated": "2010-06-17",
        "status": "A",
        "authorized_official_last_name": "MAITLAND",
        "authorized_official_first_name": "SUZANNE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "541-382-5712"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "286941",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Jun 17, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.