Active NPI
Timothy John Connelly
- Anesthesiology Physician
- Salem, OR
National Provider Identifier
1750492559
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- OR MD22748
- Practice address
- 5125 Skyline Rd S
Salem, OR 97306-9427 - Phone
- (503) 566-4520
- NPI assigned
- Aug 31, 2006
- Last updated
- Jul 12, 2007
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | OR MD22748 | OR | Primary |
| Pain Medicine Physician | 208VP0000X | OR MD22748 | OR |
Addresses
Primary practice location
5125 Skyline Rd S
Salem, OR 97306-9427
Mailing address
5125 Skyline Road S
Salem, OR 97306-9427
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 Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OR MD22748 | OR | MD | Pain Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1184198400000",
"number": "1750492559",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5125 SKYLINE ROAD S",
"city": "SALEM",
"state": "OR",
"postal_code": "973069427"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5125 SKYLINE RD S",
"city": "SALEM",
"state": "OR",
"postal_code": "973069427",
"telephone_number": "503-566-4520"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONNELLY",
"first_name": "TIMOTHY",
"middle_name": "JOHN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-31",
"last_updated": "2007-07-12",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "OR",
"license": "OR MD22748",
"primary": true
},
{
"code": "208VP0000X",
"taxonomy_group": "",
"desc": "Pain Medicine, Pain Medicine",
"state": "OR",
"license": "OR MD22748",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Salem, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.