NPIMap

Organization Active NPI

Oregon Retina, LLP

  • Ophthalmology Physician
  • Gold Beach, OR
National Provider Identifier
1750703575
Registry record updated Jan 14, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
MD20042 Issued in OR
Legal business name
OREGON RETINA, LLP
Practice address
94225 E. 4TH St.
Gold Beach, OR 97444
Phone
(541) 762-2763
NPI assigned
Jan 14, 2014
Last updated
Jan 14, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2014

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

Authorized official

Name
Albert Edwards, MD, PHDNPI 1215930763
Title
Physician/Owner
Phone
(541) 762-2763

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X MD20042 OR Primary

Addresses

Primary practice location

94225 E. 4TH St.
Gold Beach, OR 97444

Mailing address

1550 Oak St
Suite 4
Eugene, OR 97401-7701
Phone (541) 276-2763

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20121018000464 OR Part B Supplier - Clinic/Group Practice 3173773694 Receives reassigned benefits from 9 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Junction City, OR; Springfield, OR; Salem, OR; Florence, OR; Eugene, OR

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

992 Country Club Rd
Ste 102
Eugene, OR 97401
Phone (541) 687-1161

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1389657600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1389657600000",
    "number": "1750703575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1550 OAK ST",
            "address_2": "SUITE 4",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974017701",
            "telephone_number": "541-276-2763",
            "fax_number": "541-434-0912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "94225 E. 4TH ST.",
            "city": "GOLD BEACH",
            "state": "OR",
            "postal_code": "97444",
            "telephone_number": "541-762-2763"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OREGON RETINA, LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-14",
        "last_updated": "2014-01-14",
        "status": "A",
        "authorized_official_last_name": "EDWARDS",
        "authorized_official_first_name": "ALBERT",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "541-762-2763",
        "authorized_official_credential": "MD, PHD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "OR",
            "license": "MD20042",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gold Beach, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.