Myra Deline

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

201809683NP-PP Issued in OR

Practice address

1515 Village Dr Ste 100
Cottage Grove, OR 97424-9700

Phone

(541) 767-5200

Fax

(541) 767-5288

NPI assigned

Oct 9, 2018

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

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

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mdeline400775@direct.peacehealth.org

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.

• Peacehealth

  dba Cottage Grove Community Medical CT

  • Critical Access Hospital
  • Cottage Grove, OR
  • NPI 1902892391
  Medicare reassignment NPD
• Peacehealth Medical Group Cottage Grove

  • Multi-Specialty Clinic/Center
  • Creswell, OR
  • NPI 1780631267
  Medicare reassignment NPD

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

{
    "created_epoch": "1539043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571356800000",
    "number": "1689149361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3614 EMERALD ST",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974054329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 VILLAGE DR STE 100",
            "city": "COTTAGE GROVE",
            "state": "OR",
            "postal_code": "974249700",
            "telephone_number": "541-767-5200",
            "fax_number": "541-767-5288"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "425 Alexander Loop",
            "address_purpose": "LOCATION",
            "city": "Eugene",
            "state": "OR",
            "postal_code": "974016524",
            "country_code": "US",
            "telephone_number": "541-345-6199",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2360 Chambers St",
            "address_purpose": "LOCATION",
            "city": "Eugene",
            "state": "OR",
            "postal_code": "974051861",
            "country_code": "US",
            "telephone_number": "541-687-1310",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "180 Melton Rd",
            "address_purpose": "LOCATION",
            "city": "Creswell",
            "state": "OR",
            "postal_code": "974269453",
            "country_code": "US",
            "telephone_number": "541-222-7700",
            "fax_number": "541-895-5426",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "38843 Dexter Rd",
            "address_purpose": "LOCATION",
            "city": "Dexter",
            "state": "OR",
            "postal_code": "974319600",
            "country_code": "US",
            "telephone_number": "541-937-2134",
            "fax_number": "541-937-1370",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DELINE",
        "first_name": "MYRA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-09",
        "last_updated": "2019-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OR",
            "license": "201808281RN",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OR",
            "license": "201809683NP-PP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maisie L Davis
• Willie Michael Davis, HEARING AID DISPENSE
• Christopher L Dayton
• David A Debysingh, RPH
• Peter Christopher Deegan
• Madison Elizabeth Domka
• Elizabeth Marie Donnelly, MSW
• Rachel 1 Renee Dooley, RN
• Debra Marie Dowse
• Elements of Hope and Healing

• Nurse Practitioner in Cottage Grove, OR
• Providers in Cottage Grove, OR by specialty
• Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2019; 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.