Individual provider Active NPI

Mircea S. Rachita, MD

  • Internal Medicine Physician
  • Roseburg, OR
National Provider Identifier
1710963178
Registry record updated Jun 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD24593 Issued in OR
Practice address
1813 W Harvard Ave
Suite 241
Roseburg, OR 97471-2752
Phone
(541) 673-5579
Fax
(541) 673-0576
NPI assigned
Dec 19, 2005
Last updated
Jun 23, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD24593 OR Primary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X MD24593 OR

Addresses

Primary practice location

1813 W Harvard Ave
Suite 241
Roseburg, OR 97471-2752

Mailing address

2750 W Harvard Ave
Roseburg, OR 97471-2608
Phone (541) 673-8988

Other practice location 1

413 Lilly Rd NE
Olympia, WA 98506-5133
Phone (360) 493-5858

Other identifiers 1

IdentifierTypeStateIssuer
227345MedicaidOR

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mrachita99339@wm.providencedirect.org Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100630000648 WA Practitioner - Internal MedicinePractitioner - Hospitalist 1759412042 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Hospitalist
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

413 Lilly Rd NE
Olympia, WA 98506-5133
Phone (360) 493-4083

525 Lilly Rd NE
Olympia, WA 98506-5101

914 S Scheuber Rd
Centralia, WA 98531-9027
Phone (360) 736-2803

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD24593ORMDInternal Medicine Physician
24593ORMDMassage Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services Washington CurrentSince Mar 11, 2010 Accepting new patients
Providence Health & Services Washington Internal Medicine Current Accepting new patients
Providence Health & Services Washington CurrentSince Mar 11, 2010 Accepting new patients
Providence Health & Services Washington Past Accepting new patients

Locations

410 Providence Ln NE
Bldg 2
Olympia, WA 98506
Phone (360) 493-4500

413 Lilly Rd NE
Olympia, WA 98506
Phone (360) 491-9480

525 Lilly Rd NE
Olympia, WA 98506
Phone (360) 413-8550

Interoperability endpoints

  • Direct secure messaging: mrachita99339@wm.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 3

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": "1134950400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624406400000",
    "number": "1710963178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2750 W HARVARD AVE",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974712608",
            "telephone_number": "541-673-8988",
            "fax_number": "541-672-8103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1813 W HARVARD AVE",
            "address_2": "SUITE 241",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974712752",
            "telephone_number": "541-673-5579",
            "fax_number": "541-673-0576"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "413 Lilly Rd NE",
            "address_purpose": "LOCATION",
            "city": "Olympia",
            "state": "WA",
            "postal_code": "985065133",
            "country_code": "US",
            "telephone_number": "360-493-5858",
            "fax_number": "360-486-6436",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RACHITA",
        "first_name": "MIRCEA",
        "middle_name": "S.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-19",
        "last_updated": "2021-06-23",
        "certification_date": "2021-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "MD24593",
            "primary": true
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "OR",
            "license": "MD24593",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "227345",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mrachita99339@wm.providencedirect.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "413 Lilly Rd NE",
            "city": "Olympia",
            "state": "WA",
            "country_code": "US",
            "postal_code": "985065133",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Roseburg, OR

Sources for this page

Verify at the official NPI Registry.