Yc SBHC

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

201250196NP Issued in OR

Legal business name

YC SBHC

Practice address

120 Larch PL
Yamhill, OR 97148-2007

Phone

(503) 852-6960

NPI assigned

Feb 11, 2016

Last updated

Feb 11, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Michael P Jaczko, DO

Title

Medical Director

Phone

(503) 852-6960

Specialties & licenses 1

Addresses

Other identifiers 2

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/12908/brand/1/csg/1/fhir/r4

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

{
    "created_epoch": "1455148800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1455148800000",
    "number": "1801255328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 544",
            "city": "YAMHILL",
            "state": "OR",
            "postal_code": "971480544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 LARCH PL",
            "city": "YAMHILL",
            "state": "OR",
            "postal_code": "971482007",
            "telephone_number": "503-852-6960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YC SBHC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-11",
        "last_updated": "2016-02-11",
        "status": "A",
        "authorized_official_last_name": "JACZKO",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "503-852-6960",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "OR",
            "license": "201250196NP",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1487647954",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500652931",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sarah Snyder
• Verdura Family Wellness, Inc (Verdura Yamhill Carlton SBHC)
• Alexandra L Winkler
• Albert Xthona
• Yamhill Carlton School District

• Primary Care Nurse Practitioner in Yamhill, OR
• Providers in Yamhill, OR by specialty
• Primary Care Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.