NPIMap

Individual provider Active NPI

Bryan Dean Walls, D.O.

  • Family Medicine Physician
  • Portland, OR
National Provider Identifier
1710982129
Registry record updated Sep 18, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
DO20625 Issued in OR
Practice address
2306 SE 39TH Ave
Portland, OR 97214-5918
Phone
(503) 963-9181
Fax
(503) 963-9182
NPI assigned
Jun 14, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X DO20625 OR Primary

Addresses

Primary practice location

2306 SE 39TH Ave
Portland, OR 97214-5918

Mailing address

2306 SE 39TH Ave
Portland, OR 97214-5918
Phone (503) 963-9181

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
I20090119000042 OR Practitioner - Family Practice 7719040708 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
College of Osteo Med of the Pacific at Pomona, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Rogue Valley PhysiciansGroup PAC ID 1850374240, 22 clinicians

Practice addresses (Care Compare)

229 W Stewart Ave
Medford, OR 97501-3663
Phone (541) 282-8808

Hospital & facility affiliations

  • Accentcare Home Health of Rogue Valley, LLC Home health agency, Medford, OR, CCN 387098
  • Riverside Home Health Care Home health agency, Grants Pass, OR, CCN 387143
  • Providence Medford Home Care Home health agency, Medford, OR, CCN 387016
  • Providence Medford Hospice Hospice, Medford, OR, CCN 381506
  • Asante Rogue Regional Medical Center Hospital, Medford, OR, CCN 380018
  • Asante Ashland Community Hospital Hospital, Ashland, OR, CCN 380005
  • Providence Medford Medical Center Hospital, Medford, OR, CCN 380075
  • Asante Three Rivers Medical Center Hospital, Grants Pass, OR, CCN 380002

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
DO20625ORMDFamily Medicine Physician
20625ORMDAudiologist

Practice roles

OrganizationSpecialtyStatusNew patients
Rogue Valley Physicians PC Family Medicine CurrentSince Jan 1, 2022 Accepting new patients
Kaiser Foundation Health Plan of the Northwest Family Medicine CurrentSince Oct 1, 2019 Accepting new patients
Rogue Valley Physicians CurrentSince Jan 1, 2022 Accepting new patients
Providence Health & Services - Oregon CurrentSince Jul 15, 2021 Accepting new patients
Providence Health & Services - Oregon Current Accepting new patients
Rogue Valley Physicians Family Medicine Current Accepting new patients
Providence Health & Services - Oregon Family Medicine CurrentSince Jul 15, 2021 Accepting new patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Oct 1, 2019 Accepting new patients

Locations

615 S 2nd St
Central Point, OR 97502
Phone (541) 789-4004

10100 SE Sunnyside Rd
Clackamas, OR 97015
Phone (503) 571-2946

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

229 W Stewart Ave
Medford, OR 97501
Phone (541) 282-8808

2900 Doctors Park Dr
Ste 250
Medford, OR 97504
Phone (541) 282-2208

2400 Lancaster Dr NE
Salem, OR 97305
Phone (503) 361-5400

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 8

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.

Hospital & facility affiliations 8

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": "1118707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1221696000000",
    "number": "1710982129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2306 SE 39TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972145918",
            "telephone_number": "503-963-9181",
            "fax_number": "503-963-9182"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2306 SE 39TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972145918",
            "telephone_number": "503-963-9181",
            "fax_number": "503-963-9182"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLS",
        "first_name": "BRYAN",
        "middle_name": "DEAN",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-14",
        "last_updated": "2008-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "DO20625",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.