Davera Corporation

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

DAVERA CORPORATION

Practice address

214 NE Outlook Ave
Grants Pass, OR 97526-1412

Phone

(541) 471-1909

Fax

(541) 471-1928

NPI assigned

Jan 29, 2019

Organization subpart

No

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

Authorized official

Name

David Ray, DC, FNPNPI 1811135759

Title

President

Phone

(541) 471-1909

Specialties & licenses 4

Addresses

Other names 1

• REDWOOD FAMILY PRACTICE Doing business as

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Interoperability endpoints

• Direct secure messaging: michellekitchen@redfp.allscriptsdirect.net
• Direct secure messaging: davidray@redfp.allscriptsdirect.net

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• David Michael Ray, FNP

  • Family Nurse Practitioner
  • Grants Pass, OR
  • NPI 1811135759

  Chiropractor, OR

  Medicare reassignment NPD Authorized official
• Michelle Antoinette Kitchen, FNP

  • Family Nurse Practitioner
  • Grants Pass, OR
  • NPI 1114771698

  Family, OR

  Medicare reassignment NPD

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

{
    "created_epoch": "1548720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583884800000",
    "number": "1760946321",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "214 NE OUTLOOK AVE",
            "city": "GRANTS PASS",
            "state": "OR",
            "postal_code": "975261412",
            "telephone_number": "541-471-1909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "214 NE OUTLOOK AVE",
            "city": "GRANTS PASS",
            "state": "OR",
            "postal_code": "975261412",
            "telephone_number": "541-471-1909",
            "fax_number": "541-471-1928"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVERA CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-29",
        "last_updated": "2020-03-11",
        "certification_date": "2020-03-11",
        "status": "A",
        "authorized_official_last_name": "RAY",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "541-471-1909",
        "authorized_official_credential": "DC, FNP"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225700000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Massage Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "REDWOOD FAMILY PRACTICE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "REDWOOD FAMILY PRACTICE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Daniel Dirk
• Daniel L Moline, MD, PC
• James Brant Darby, DDS
• Darren S Huddleston DMD PC
• Caroline Lazaga Dasalla, RN
• David D. Candelaria, MD
• David F. Young MD PC
• David R. Willing, DC, LLC
• Christopher K David, MD
• James Lowell Davidian, MD

• All providers in Grants Pass, OR
• Family Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.