Active NPI
Charles S. Ross, D.O.
- Family Medicine Physician
- Eugene, OR
National Provider Identifier
1740275932
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- DO10012
- Practice address
- 3910 Mirror Pond Way
Eugene, OR 97408-5954 - Phone
- (541) 680-0361
- Fax
- (541) 200-6530
- NPI assigned
- Sep 14, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | DO10012 | OR | |
| General Practice Physician | 208D00000X | DO10012 | OR | |
| Family Medicine Physician | 207Q00000X | DO10012 | OR | Primary |
Addresses
Primary practice location
3910 Mirror Pond Way
Eugene, OR 97408-5954
Mailing address
3910 Mirror Pond Way
Eugene, OR 97408-5954
Phone (541) 680-0361
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 165878 | Medicaid | OR | |
| 1740275932 | Medicaid | OR | |
| 000188024 | Other | OR | BCBS |
| 168395 | Medicaid | OR | |
| R103163 | Other | MEDICARE PART B |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DO10012 | OR | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1126656000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1747785600000",
"number": "1740275932",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3910 MIRROR POND WAY",
"city": "EUGENE",
"state": "OR",
"postal_code": "974085954",
"telephone_number": "541-680-0361",
"fax_number": "541-200-6530"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3910 MIRROR POND WAY",
"city": "EUGENE",
"state": "OR",
"postal_code": "974085954",
"telephone_number": "541-680-0361",
"fax_number": "541-200-6530"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROSS",
"first_name": "CHARLES",
"middle_name": "S.",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-09-14",
"last_updated": "2025-05-21",
"certification_date": "2025-05-21",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "OR",
"license": "DO10012",
"primary": false
},
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "OR",
"license": "DO10012",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "OR",
"license": "DO10012",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "165878",
"state": "OR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1740275932",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "000188024",
"state": "OR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "168395",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PART B",
"identifier": "R103163",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Eugene, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.