Carly Mauch, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA01409 Issued in OR

Practice address

1813 W Harvard Ave
Suite #310
Roseburg, OR 97471-2752

Phone

(541) 672-7546

NPI assigned

Jan 8, 2008

Last updated

Nov 29, 2017By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

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: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• James M Yun MD PC

  dba ENT Associates of Roseburg LLC

  • Otolaryngology Physician
  • Roseburg, OR
  • NPI 1255667747
  Medicare reassignment
• ENT Associates of Roseburg LLC

  • Otolaryngology Physician
  • Roseburg, OR
  • NPI 1902132483
  NPD

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

{
    "created_epoch": "1199750400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1511913600000",
    "number": "1679758700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2423 NW TROOST ST",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974711706",
            "telephone_number": "541-677-3400",
            "fax_number": "541-677-3405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1813 W HARVARD AVE",
            "address_2": "SUITE #310",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974712752",
            "telephone_number": "541-672-7546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAUCH",
        "first_name": "CARLY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-01-08",
        "last_updated": "2017-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA01409",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "R144364",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Isabella J Mast
• Roland Price Matthews
• Carmen Negrete Matthis, PHARMD
• Kyle G Matz, LMFT
• Nichole Renne Matz, BS
• Joe Maxey, BS
• Joy L Maxwell, RN
• Beatrice Mupenzi May
• Jerry Powell May, D.M.D.
• Sunny L May, WHNP

• Physician Assistant in Roseburg, OR
• Providers in Roseburg, OR by specialty
• Physician Assistant in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.