Active NPI
Janette J Banasiak, 762296
- Contractor
- Monmouth, OR
National Provider Identifier
1861850661
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Contractor
- License
- 762296
- Practice address
- 422 Heffley St S
Monmouth, OR 97361-9728 - Phone
- (503) 983-8077
- NPI assigned
- Feb 8, 2016
- Last updated
- Feb 8, 2016
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Contractor | 171W00000X | 762296 | OR | Primary |
Addresses
Primary practice location
422 Heffley St S
Monmouth, OR 97361-9728
Mailing address
422 Heffley St S
Monmouth, OR 97361-9728
Phone (503) 983-8077
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 762296 | OR | MD | Contractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1454889600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1454889600000",
"number": "1861850661",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "422 HEFFLEY ST S",
"city": "MONMOUTH",
"state": "OR",
"postal_code": "973619728",
"telephone_number": "503-983-8077"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "422 HEFFLEY ST S",
"city": "MONMOUTH",
"state": "OR",
"postal_code": "973619728",
"telephone_number": "503-983-8077"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BANASIAK",
"first_name": "JANETTE",
"middle_name": "J",
"credential": "762296",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-02-08",
"last_updated": "2016-02-08",
"status": "A"
},
"taxonomies": [
{
"code": "171W00000X",
"taxonomy_group": "",
"desc": "Contractor",
"state": "OR",
"license": "762296",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Monmouth, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 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.