Klamath Orthopedic Clinic PC

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

KLAMATH ORTHOPEDIC CLINIC PC

Practice address

2200 Bryant Williams Dr
Suite 1
Klamath Falls, OR 97601-1120

Phone

(541) 884-7746

Fax

(541) 274-5705

NPI assigned

Jul 25, 2006

Organization subpart

No

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

Authorized official

Name

Jeannette Gansberg

Title

Executive Director

Phone

(541) 274-2902

Specialties & licenses 1

Addresses

Other identifiers 10

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Practitioners 8

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.

• Gillian Bayley, M.D.

  • Orthopaedic Foot and Ankle Surgery Physician
  • Klamath Falls, OR
  • NPI 1902258080
  Medicare reassignment NPD
• Traci Nichole Gansberg, FNP

  • Family Nurse Practitioner
  • Klamath Falls, OR
  • NPI 1336692813
  Medicare reassignment NPD
• Fred F. Naraghi, M.D.

  • Orthopaedic Surgery of the Spine Physician
  • Klamath Falls, OR
  • NPI 1235159856
  Medicare reassignment NPD
• Joshua David Dworkin, M.D.

  • Student in an Organized Health Care Education/Training Program
  • Tripler Army Medical Center, HI
  • NPI 1811247620

  OR

  Medicare reassignment NPD
• Joshua Aaron Martin, PA

  • Surgical Physician Assistant
  • Klamath Falls, OR
  • NPI 1659898633
  Medicare reassignment
• Michael Patrick McCullough, DPM

  • Podiatrist
  • Klamath Falls, OR
  • NPI 1982692661
  Medicare reassignment
• Edward L Van Tassel, DO

  • Orthopaedic Surgery Physician
  • Klamath Falls, OR
  • NPI 1093737199
  Medicare reassignment
• Samantha N Lee, PA-C

  • Physician Assistant
  • Mountain View, CA
  • NPI 1033751912

  OR

  Medicare reassignment

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

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718755200000",
    "number": "1811919913",
    "addresses": [
        {
            "country_code": "UM",
            "country_name": "United States Minor Outlying Islands",
            "address_purpose": "MAILING",
            "address_type": "FGN",
            "address_1": "2200 BRYANT WILLIAMS DRIVE",
            "address_2": "SUITE 1",
            "city": "KLAMATH FALLS",
            "state": "OREGON",
            "postal_code": "976011121",
            "telephone_number": "541-884-7746",
            "fax_number": "541-274-5705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 BRYANT WILLIAMS DR",
            "address_2": "SUITE 1",
            "city": "KLAMATH FALLS",
            "state": "OR",
            "postal_code": "976011120",
            "telephone_number": "541-884-7746",
            "fax_number": "541-274-5705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KLAMATH ORTHOPEDIC CLINIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-25",
        "last_updated": "2024-06-19",
        "certification_date": "2024-06-19",
        "status": "A",
        "authorized_official_last_name": "GANSBERG",
        "authorized_official_first_name": "JEANNETTE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "541-274-2902"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "200010673",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "200044954",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "CO3632",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "P01815487",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P01702513",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "002635000",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500679872",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P01432107",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "284783",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "261198",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Klamath Hospice, Inc.
• Klamath Medical Clinic PC
• Klamath Ophthalmology PC (Klamath Eye Center)
• Klamath Ophthalmology PC (Downtown Optical)
• Klamath Ophthalmology PC (Benson Eye Center)
• Klamath Pain Clinic PC
• Klamath Pathology Associates, PC
• Klamath Pediatric Clinic, PC
• Klamath Physician Assistants LLC
• Klamath Psychological Assessment Services, Inc.

• Specialist in Klamath Falls, OR
• Providers in Klamath Falls, OR by specialty
• Specialist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2024; 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.