Jacquelyn Outcalt Groshong, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

MD18388 Issued in OR

Practice address

201 Medical Loop Rd
Suite 170
Roseburg, OR 97471-8835

Phone

(541) 957-5437

Fax

(541) 464-5441

NPI assigned

Aug 2, 2006

Last updated

Sep 10, 2015By 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 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Kidsdocs PC

  • Pediatrics Physician
  • Roseburg, OR
  • NPI 1134136013
  NPD (past) Authorized official

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

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1441843200000",
    "number": "1700893674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1700",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974700414",
            "telephone_number": "541-957-5437",
            "fax_number": "541-464-5441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 MEDICAL LOOP RD",
            "address_2": "SUITE 170",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974718835",
            "telephone_number": "541-957-5437",
            "fax_number": "541-464-5441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GROSHONG",
        "first_name": "JACQUELYN",
        "middle_name": "OUTCALT",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-02",
        "last_updated": "2015-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OR",
            "license": "MD18388",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "070511",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Samantha Birenbaum Griffin, FNP
• Ryann Grindstaff
• Lee Ann Grogan, QMHP- LPC INTERN
• Andrew Groshong, MD
• Aric A Groshong, MD
• Natalie Groshong, MD
• Angela Marie Gross
• Dorena Elizabeth Guido, RN
• Jessica Lynn Guido, FNP
• Martha Reina Guillen, LPN

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.