Active NPI
Dirk G Debroekert, PA-C
- Physician Assistant
- Eugene, OR
National Provider Identifier
1770698102
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PP00278
- Practice address
- 890 River Rd
Eugene, OR 97404-3233 - Phone
- (541) 688-0674
- Fax
- (541) 688-5378
- NPI assigned
- Aug 19, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PP00278 | OR | Primary |
Addresses
Primary practice location
890 River Rd
Eugene, OR 97404-3233
Mailing address
28015 Briggs Hill Rd
Eugene, OR 97405-9747
Phone (541) 687-8298
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
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PP00278 | OR | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155945600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1770698102",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "28015 BRIGGS HILL RD",
"city": "EUGENE",
"state": "OR",
"postal_code": "974059747",
"telephone_number": "541-687-8298"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "890 RIVER RD",
"city": "EUGENE",
"state": "OR",
"postal_code": "974043233",
"telephone_number": "541-688-0674",
"fax_number": "541-688-5378"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEBROEKERT",
"first_name": "DIRK",
"middle_name": "G",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-19",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "OR",
"license": "PP00278",
"primary": true
}
],
"identifiers": [],
"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 Jul 8, 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.