NPIMap

Individual provider Active NPI

Jon D Prulhiere, MD

  • Internal Medicine Physician
  • Medford, OR
National Provider Identifier
1700857174
Registry record updated Nov 26, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD23533 Issued in OR
Practice address
1200 Mira Mar Ave
Medford, OR 97504-8546
Phone
(541) 664-5151
NPI assigned
Feb 1, 2006
Last updated
Nov 26, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD23533 OR Primary

Addresses

Primary practice location

1200 Mira Mar Ave
Medford, OR 97504-8546

Mailing address

1208 Beall LN
Central Point, OR 97502-1573
Phone (541) 664-5151

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051221000727 OR Practitioner - Family Practice 8123040888 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Oregon Health Sciences University School of Medicine, 1998
Medicare assignment
May accept Medicare assignment
Group practices
County of TillamookGroup PAC ID 3173411287, shared by 3 NPIs, 9 clinicians

Practice addresses (Care Compare)

801 Pacific Ave
Tillamook, OR 97141-3926
Phone (503) 842-3900

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD23533ORMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northwest Medical Foundation of Tillamook CurrentSince Oct 18, 2021 Accepting new patients
Providence Health & Services - Oregon Internal Medicine Current Accepting new patients
Providence Health & Services - Oregon Internal Medicine CurrentSince Jun 1, 2023 Accepting new patients
Northwest Medical Foundation of Tillamook CurrentSince Oct 18, 2021 Accepting new patients
County of Tillamook Past Accepting new patients

Locations

9205 SW Barnes Rd
Portland, OR 97225
Phone (503) 216-1234

1000 3rd St
Tillamook, OR 97141
Phone (503) 251-6129

1000 3rd St
#M
Tillamook, OR 97141
Phone (503) 815-2260

1100 3rd St
Tillamook, OR 97141
Phone (503) 815-2116

Interoperability endpoints

  • Direct secure messaging: jprulhiere2867585@oc.providencedirect.org

Organizations & group practices 5

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.

Hospital & facility affiliations 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1138752000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196035200000",
    "number": "1700857174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1208 BEALL LN",
            "city": "CENTRAL POINT",
            "state": "OR",
            "postal_code": "975021573",
            "telephone_number": "541-664-5151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 MIRA MAR AVE",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975048546",
            "telephone_number": "541-664-5151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRULHIERE",
        "first_name": "JON",
        "middle_name": "D",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-01",
        "last_updated": "2007-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "MD23533",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Medford, OR

Sources for this page

Verify at the official NPI Registry.