Individual provider Active NPI

Dianne K Koenig, PA

  • Medical Physician Assistant
  • McMinnville, OR
National Provider Identifier
1710040076
Registry record updated Jan 9, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA00605 Issued in OR
Practice address
2435 NE Cumulus Ave Ste a
McMinnville, OR 97128-8862
Phone
(503) 472-6161
Fax
(503) 434-6290
NPI assigned
Dec 18, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA00605 OR Primary

Addresses

Primary practice location

2435 NE Cumulus Ave Ste a
McMinnville, OR 97128-8862

Mailing address

2435 NE Cumulus Ave Ste a
McMinnville, OR 97128-8862
Phone (503) 472-6161

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20050714000445 OR Practitioner - Physician Assistant 5799711339 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Physicians Medical Center P CGroup PAC ID 6305832890, 21 clinicians

Practice addresses (Care Compare)

2435 NE Cumulus Ave
Suite a
McMinnville, OR 97128-8805
Phone (503) 472-6161

2435 NE Cumulus Ave a
McMinnville, OR 97128-8862

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Physicians Medical Center P C CurrentSince Jun 20, 2005 Accepting new patients

Locations

2435 NE Cumulus Ave
Ste A
McMinnville, OR 97128
Phone (503) 472-6161

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1357689600000",
    "number": "1710040076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2435 NE CUMULUS AVE STE A",
            "city": "MCMINNVILLE",
            "state": "OR",
            "postal_code": "971288862",
            "telephone_number": "503-472-6161",
            "fax_number": "503-434-6290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2435 NE CUMULUS AVE STE A",
            "city": "MCMINNVILLE",
            "state": "OR",
            "postal_code": "971288862",
            "telephone_number": "503-472-6161",
            "fax_number": "503-434-6290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOENIG",
        "first_name": "DIANNE",
        "middle_name": "K",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-18",
        "last_updated": "2013-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OR",
            "license": "PA00605",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in McMinnville, OR

Sources for this page

Verify at the official NPI Registry.