Active NPI
Jennifer L Canganelli, R.D., C.D.E.
- Registered Dietitian
- Medford, OR
National Provider Identifier
1861415564
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- ND 3966
- Practice address
- 2900 E Barnett Rd Ste 2
Medford, OR 97504-8380 - Phone
- (541) 789-5906
- NPI assigned
- Jul 25, 2006
- Last updated
- Jul 21, 2022
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | ND 3966 | FL | Primary |
Addresses
Primary practice location
2900 E Barnett Rd Ste 2
Medford, OR 97504-8380
Mailing address
759 Hilldale Ave
Medford, OR 97504-8223
Phone (352) 572-6503
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 297594 | Other | FL | AVMED VENDOR NUMBER |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ND 3966 | FL | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Asante | Past | Accepting new patients | |
| Diatrition Inc | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153785600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1861415564",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "759 HILLDALE AVE",
"city": "MEDFORD",
"state": "OR",
"postal_code": "975048223",
"telephone_number": "352-572-6503"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2900 E BARNETT RD STE 2",
"city": "MEDFORD",
"state": "OR",
"postal_code": "975048380",
"telephone_number": "541-789-5906"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CANGANELLI",
"first_name": "JENNIFER",
"middle_name": "L",
"credential": "R.D., C.D.E.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-25",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "FL",
"license": "ND 3966",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AVMED VENDOR NUMBER",
"identifier": "297594",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Medford, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.