NPIMap

Individual provider Active NPI

Kenneth Haugen, M.D.

  • Radiation Oncology Physician
  • Medford, OR
National Provider Identifier
1710946959
Registry record updated Aug 5, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
License
MD21714 Issued in OR
Practice address
1111 Crater Lake Ave
Medford, OR 97504-6241
Phone
(541) 732-7000
NPI assigned
Mar 17, 2006
Last updated
Aug 5, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiation Oncology Physician 2085R0001X MD21714 OR Primary

Addresses

Primary practice location

1111 Crater Lake Ave
Medford, OR 97504-6241

Mailing address

PO Box 8509
Medford, OR 97501-5009
Phone (541) 772-0023

Other identifiers 2

IdentifierTypeStateIssuer
139446MedicaidOR
MD21714OtherOROREGON STATE LICENSE

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
I20101104001245 OR Practitioner - Radiation Oncology 2668548280 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Radiation Oncology
Education
Loma Linda University School of Dentistry, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sky Lakes Medical Center IncGroup PAC ID 1052204096, 196 clinicians
Radiation Oncology Group Consultants P CGroup PAC ID 0446248405, 5 clinicians

Practice addresses (Care Compare)

2610 Uhrmann Rd
Klamath Falls, OR 97601-1123
Phone (541) 274-6262

2825 E Barnett Rd
Medford, OR 97504-8332
Phone (541) 789-4263

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD21714ORMDRadiation Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sky Lakes Medical Center Inc CurrentSince Oct 28, 2022 Accepting new patients
Radiation Oncology Group Consultants, PC Radiation Oncology CurrentSince Apr 16, 1999 Accepting new patients
Sky Lakes Medical Center Inc CurrentSince Oct 28, 2022 Accepting new patients

Locations

2610 Uhrmann Rd
Klamath Falls, OR 97601
Phone (541) 274-4171

2865 Daggett Ave
Klamath Falls, OR 97601
Phone (541) 833-6221

1111 Crater Lake Ave
Medford, OR 97504
Phone (541) 732-5250

2825 E Barnett Rd
Medford, OR 97504
Phone (541) 282-6770

Organizations & group practices 3

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 7

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

NPI Registry JSON

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

{
    "created_epoch": "1142553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1280966400000",
    "number": "1710946959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8509",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975015009",
            "telephone_number": "541-772-0023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 CRATER LAKE AVE",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975046241",
            "telephone_number": "541-732-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAUGEN",
        "first_name": "KENNETH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-17",
        "last_updated": "2010-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "OR",
            "license": "MD21714",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "139446",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OREGON STATE LICENSE",
            "identifier": "MD21714",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Medford, OR

Sources for this page

Verify at the official NPI Registry.