NPIMap

Organization Active NPI

Ventana Wellness, PC

  • Family Medicine Physician
  • Medford, OR
National Provider Identifier
1720012339
Registry record updated Nov 16, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
06-00024661 Issued in OR
Legal business name
VENTANA WELLNESS, PC
Practice address
3156 State Street
Medford, OR 97504-8450
Phone
(541) 773-9772
Fax
(541) 773-1113
NPI assigned
Jul 10, 2006
Last updated
Nov 16, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2015

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

Authorized official

Name
Mr. Frank Richard Noodleman, MD
Title
Owner
Phone
(541) 773-9772

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 06-00024661 OR Primary

Addresses

Primary practice location

3156 State Street
Medford, OR 97504-8450

Mailing address

3156 State Street
Medford, OR 97504-8450
Phone (541) 773-9772

Other identifiers 1

IdentifierTypeStateIssuer
287179MedicaidOR

Other names 1

  • Southern Oregon Health and Wellness Former legal business name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1447632000000",
    "number": "1720012339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3156 STATE STREET",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975048450",
            "telephone_number": "541-773-9772",
            "fax_number": "541-773-1113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3156 STATE STREET",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975048450",
            "telephone_number": "541-773-9772",
            "fax_number": "541-773-1113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VENTANA WELLNESS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-10",
        "last_updated": "2015-11-16",
        "status": "A",
        "authorized_official_last_name": "NOODLEMAN",
        "authorized_official_first_name": "FRANK",
        "authorized_official_middle_name": "RICHARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "541-773-9772",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "06-00024661",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "287179",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern Oregon Health and Wellness",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Medford, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 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.