NPIMap

Organization Active NPI

Bend Memorial Clinic PC

Doing business as Summit Health

  • Family Medicine Physician
  • Bend, OR
National Provider Identifier
1699827477
Registry record updated Apr 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
BEND MEMORIAL CLINIC PC
Doing business as
Summit Health
Practice address
1501 NE Medical Center Dr
Bend, OR 97701-6051
Phone
(541) 382-2811
NPI assigned
Jan 18, 2007
Last updated
Apr 21, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2023

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

Authorized official

Name
Jessie Dover
Title
Credentialing Coordinator
Phone
(541) 706-2495

Specialties & licenses 15

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU
Dermatology Physician 207N00000X NU
MOHS-Micrographic Surgery Physician 207ND0101X NU
Family Medicine Physician 207Q00000X NU Primary
Internal Medicine Physician 207R00000X NU
Cardiovascular Disease Physician 207RC0000X NU
Endocrinology, Diabetes & Metabolism Physician 207RE0101X NU
Gastroenterology Physician 207RG0100X NU
Hematology & Oncology Physician 207RH0003X NU
Nephrology Physician 207RN0300X NU
Pulmonary Disease Physician 207RP1001X NU
Rheumatology Physician 207RR0500X NU
Medical Oncology Physician 207RX0202X NU
Ophthalmology Physician 207W00000X NU
Surgery Physician 208600000X NU

Addresses

Primary practice location

1501 NE Medical Center Dr
Bend, OR 97701-6051

Mailing address

1501 NE Medical Center Dr
Bend, OR 97701-6051
Phone (541) 382-2811

Other identifiers 1

IdentifierTypeStateIssuer
213243MedicaidOR

Other names 1

  • Summit Health Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20061215000022 OR Part B Supplier - Clinic/Group Practice 7214936533 Receives reassigned benefits from 404 practitioners
1 other NPI on this enrollment
Practice locations: Bend, OR; La Pine, OR; Madras, OR; Redmond, OR; Sisters, OR; Sunriver, OR
O20100930069168 OR DME Supplier - Physician - OphthalmologyDME Supplier - Sleep Laboratory/MedicineDME Supplier - Physician - Family PracticeDME Supplier - Physician AssistantDME Supplier - OpticianDME Supplier - Physician - Emergency MedicineDME Supplier - Physician - Hematology/OncologyDME Supplier - Physician - Vascular SurgeryDME Supplier - Physician - RheumatologyDME Supplier - Nurse PractitionerDME Supplier - Physician - PodiatryDME Supplier - Physician - OptometristDME Supplier - Physician - EndocrinologyDME Supplier - Physician - CardiologyDME Supplier - Physician - Internal MedicineDME Supplier - Physician - NeurologyDME Supplier - Physician - NeurosurgeryDME Supplier - Physician - Physical and RehabilitationDME Supplier - Physician - Orthopedic/Orthopedic SurgeryDME Supplier - Physician - NephrologyDME Supplier - Physician - Pulmonary Disease 7214936533 Practice locations: Bend, OR

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
38D0628274Summit Health City MD +1501 NE Medical Center Dr, Bend, OR 97701ComplianceMay 18, 2028

National Provider Directory

National Provider Directory

Locations

815 SW Bond St
Bend, OR 97702
Phone (541) 382-4900

815 SW Bond St
Ste 100
Bend, OR 97702

1001 NW Canal Blvd
Ste A
Redmond, OR 97756
Phone (541) 382-4900

231 E Cascade Ave
Sisters, OR 97759
Phone (541) 382-4900

Practitioners & affiliated clinicians

Practitioners 411

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 411

NPI Registry JSON

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682035200000",
    "number": "1699827477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 NE MEDICAL CENTER DR",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977016051",
            "telephone_number": "541-382-2811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 NE MEDICAL CENTER DR",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977016051",
            "telephone_number": "541-382-2811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEND MEMORIAL CLINIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-18",
        "last_updated": "2023-04-21",
        "certification_date": "2023-04-21",
        "status": "A",
        "authorized_official_last_name": "DOVER",
        "authorized_official_first_name": "JESSIE",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "541-706-2495"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RR0500X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Rheumatology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RX0202X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Medical Oncology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "213243",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Summit Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Apr 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.