Active NPI
Thomas Craig Detweiler, M.D.
- Internal Medicine Physician
- Medford, OR
National Provider Identifier
1659310704
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- MD164287
- Practice address
- 965 Ellendale Dr
Medford, OR 97504 - Phone
- (541) 732-6000
- NPI assigned
- Jun 5, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 039504L | PA | |
| Internal Medicine Physician | 207R00000X | MD164287 | OR | Primary |
Addresses
Primary practice location
965 Ellendale Dr
Medford, OR 97504
Mailing address
PO Box 3158
Portland, OR 97208-3158
Phone (541) 732-6000
Other practice location 1
2405 N Broad St
Colmar, PA 18915-9406
Phone (215) 822-6333
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 500670934 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 039504L | PA | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Thomas C Detweiler,MD | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Custodial Care Facility
- Colmar, PA
- NPI 1528495595
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149465600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1576800000000",
"number": "1659310704",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3158",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972083158",
"telephone_number": "541-732-6000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "965 ELLENDALE DR",
"city": "MEDFORD",
"state": "OR",
"postal_code": "97504",
"telephone_number": "541-732-6000"
}
],
"practiceLocations": [
{
"address_1": "2405 N Broad St",
"address_purpose": "LOCATION",
"city": "Colmar",
"state": "PA",
"postal_code": "189159406",
"country_code": "US",
"telephone_number": "215-822-6333",
"fax_number": "215-822-1891",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "DETWEILER",
"first_name": "THOMAS",
"middle_name": "CRAIG",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-05",
"last_updated": "2019-12-20",
"certification_date": "2019-12-20",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "PA",
"license": "039504L",
"primary": false
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "OR",
"license": "MD164287",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "500670934",
"state": "OR"
}
],
"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 Dec 20, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.