Organization Active NPI

Path to Awareness PC

  • Psychiatry Physician
  • Bend, OR
National Provider Identifier
1811484603
Registry record updated Apr 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
MD28568 Issued in OR
Legal business name
PATH TO AWARENESS PC
Practice address
2239 NE Doctors Dr Ste 110
Bend, OR 97701-7185
Phone
(541) 323-8705
Fax
(541) 323-8708
NPI assigned
Apr 17, 2018
Last updated
Apr 27, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2023

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

Authorized official

Name
Faith Brown
Title
Practice Manager
Phone
(541) 323-8705

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X MD28568 OR Primary

Addresses

Primary practice location

2239 NE Doctors Dr Ste 110
Bend, OR 97701-7185

Mailing address

2239 NE Doctors Dr Ste 110
Bend, OR 97701-7185
Phone (541) 323-8705

Other practice location 1

809 E Jackson St
Medford, OR 97504-6713
Phone (541) 245-3614

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200423003106 OR Part B Supplier - Clinic/Group Practice 4587094057 Receives reassigned benefits from 1 practitioner
Practice locations: Medford, OR; Bend, OR

National Provider Directory

National Provider Directory

Locations

2239 NE Doctors Dr
Ste 110
Bend, OR 97701
Phone (541) 245-3614

Practitioners & affiliated clinicians

Practitioners 6

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": "1523923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682553600000",
    "number": "1811484603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2239 NE DOCTORS DR STE 110",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977017185",
            "telephone_number": "541-323-8705",
            "fax_number": "541-323-8707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2239 NE DOCTORS DR STE 110",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977017185",
            "telephone_number": "541-323-8705",
            "fax_number": "541-323-8708"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "809 E Jackson St",
            "address_purpose": "LOCATION",
            "city": "Medford",
            "state": "OR",
            "postal_code": "975046713",
            "country_code": "US",
            "telephone_number": "541-245-3614",
            "fax_number": "541-245-3549",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PATH TO AWARENESS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-17",
        "last_updated": "2023-04-27",
        "certification_date": "2023-04-27",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "FAITH",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "541-323-8705"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "OR",
            "license": "MD28568",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bend, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2023; 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.