Individual provider Active NPI

Jeffrey Rich Davis, MD

  • Otolaryngology Physician
  • Longview, WA
National Provider Identifier
1871507251
Registry record updated Jul 25, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
MD00038750 Issued in WA
Practice address
1801 1St Ave
Suite 3a
Longview, WA 98632
Phone
(360) 636-4469
Fax
(360) 425-4970
NPI assigned
Jul 28, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X MD00038750 WA Primary

Addresses

Primary practice location

1801 1St Ave
Suite 3a
Longview, WA 98632

Mailing address

1801 1St Ave
Suite 3a
Longview, WA 98632
Phone (360) 636-4469

Other identifiers 1

IdentifierTypeStateIssuer
8256067MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070219000437 WA Practitioner - Otolaryngology 6204938426 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Baylor College of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
PeacehealthGroup PAC ID 8820178288, 245 clinicians

Practice addresses (Care Compare)

417 SE 164TH Ave
Suite 300
Vancouver, WA 98684-8944
Phone (360) 256-4425

505 NE 87TH Ave
Vancouver, WA 98664-1965

8821 NE 5TH St
Vancouver, WA 98664-3200
Phone (360) 514-1900

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Peacehealth CurrentSince Jan 23, 2017 Accepting new patients
Peacehealth CurrentSince Jan 23, 2017 Accepting new patients

Locations

1615 Delaware St
Longview, WA 98632
Phone (360) 363-4818

1801 1st Ave
Ste 3A
Longview, WA 98632
Phone (360) 256-4425

14411 NE 20th Ave
Ste 101
Vancouver, WA 98686
Phone (360) 256-4425

505 NE 87th Ave
Ste 301
Vancouver, WA 98664
Phone (360) 514-1854

1405 SE 164th Ave
Ste 102
Vancouver, WA 98683
Phone (360) 253-4405

1115 SE 164th Ave
Dept 364
Vancouver, WA 98683
Phone (360) 735-8100

Interoperability endpoints

  • Direct secure messaging: jdavis50673@direct.peacehealth.org

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 and National Provider Directory roles.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1185321600000",
    "number": "1871507251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1801 1ST AVE",
            "address_2": "SUITE 3A",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "98632",
            "telephone_number": "360-636-4469",
            "fax_number": "360-425-4970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 1ST AVE",
            "address_2": "SUITE 3A",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "98632",
            "telephone_number": "360-636-4469",
            "fax_number": "360-425-4970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "JEFFREY",
        "middle_name": "RICH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-28",
        "last_updated": "2007-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "WA",
            "license": "MD00038750",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8256067",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Longview, WA

Sources for this page

Verify at the official NPI Registry.