Individual provider Active NPI

Breanna Davis, CNM, WHNP

  • Advanced Practice Midwife
  • Bend, OR
National Provider Identifier
1649828286
Registry record updated Aug 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Advanced Practice MidwifeTaxonomy code 367A00000X
License
10006160 Issued in OR
Practice address
2500 NE Neff Rd
Bend, OR 97701-6015
Phone
(541) 382-4321
NPI assigned
Aug 27, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Advanced Practice Midwife 367A00000X PENDING CA
Advanced Practice Midwife 367A00000X 10006160 OR Primary

Addresses

Primary practice location

2500 NE Neff Rd
Bend, OR 97701-6015

Mailing address

PO Box 6095
Bend, OR 97708-6095
Phone (541) 706-5922

Other practice location 1

24411 Health Center Dr Ste 200
Laguna Hills, CA 92653-3633
Phone (949) 829-5500

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address bdavis177957@secure.stcharleshealthcare.org

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230530000516 OR Practitioner - Certified Nurse Midwife (CNM) 1254798713 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Midwife

State licenses

LicenseStateTypeSpecialty
PENDINGCAMDDentist
10006160ORMDAdvanced Practice Midwife

Practice roles

OrganizationSpecialtyStatusNew patients
St. Charles Health System, Inc. CurrentSince Jul 1, 2023 Accepting new patients
St. Charles Health System, Inc. CurrentSince Jul 1, 2023 Accepting new patients
St. Charles Health System, Inc. Current Accepting new patients
St. Charles Health System, Inc. CurrentSince Jul 1, 2023 Accepting new patients
St. Charles Health System, Inc. CurrentSince Jul 1, 2023 Accepting new patients
St. Charles Health System, Inc. Past Accepting new patients

Locations

29358 Network Pl
Chicago, IL 60673

1345 NW Wall St
Ste 200
Bend, OR 97703
Phone (541) 330-2103

2500 NE Neff Rd
Bend, OR 97701
Phone (541) 388-4333

1253 NW Canal Blvd
Redmond, OR 97756
Phone (541) 548-8131

340 NW 5th St
Ste 101
Redmond, OR 97756
Phone (734) 545-3348

211 NW Larch Ave
Redmond, OR 97756
Phone (541) 548-2164

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1566864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690934400000",
    "number": "1649828286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6095",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977086095",
            "telephone_number": "541-706-5922",
            "fax_number": "541-706-6869"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 NE NEFF RD",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977016015",
            "telephone_number": "541-382-4321"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "24411 Health Center Dr Ste 200",
            "address_purpose": "LOCATION",
            "city": "Laguna Hills",
            "state": "CA",
            "postal_code": "926533633",
            "country_code": "US",
            "telephone_number": "949-829-5500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "BREANNA",
        "credential": "CNM, WHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-27",
        "last_updated": "2023-08-02",
        "certification_date": "2023-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "CA",
            "license": "PENDING",
            "primary": false
        },
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "OR",
            "license": "10006160",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bdavis177957@secure.stcharleshealthcare.org",
            "affiliation": "N",
            "address_1": "2500 NE Neff Rd",
            "city": "Bend",
            "state": "OR",
            "country_code": "US",
            "postal_code": "977016015",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Bend, OR

Sources for this page

Verify at the official NPI Registry.