Individual provider Active NPI

Abby Ehntholt, N.P.

  • Family Nurse Practitioner
  • Bend, OR
National Provider Identifier
1871969022
Registry record updated Aug 31, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
33340757 Issued in NY
Practice address
2195 NW Shevlin Park Rd Ste 100
Bend, OR 97703-7102
Phone
(541) 706-3819
Fax
(541) 429-6659
NPI assigned
Aug 11, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X 101.0114340 VT
Family Nurse Practitioner 363LF0000X 33340757 NY Primary

Addresses

Primary practice location

2195 NW Shevlin Park Rd Ste 100
Bend, OR 97703-7102

Mailing address

PO Box 1517
Pendleton, OR 97801-0410
Phone (877) 708-1119

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, OR2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20190502000836 WA Practitioner - Nurse Practitioner 8022306281
I20210503000631 OR Practitioner - Nurse Practitioner 8022306281 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bend Memorial Clinic PCGroup PAC ID 7214936533, 225 clinicians

Practice addresses (Care Compare)

815 SW Bond St
Suite 100
Bend, OR 97702-3593
Phone (541) 706-2525

Hospital & facility affiliations

  • St Charles Medical Center - Bend Hospital, Bend, OR, CCN 380047

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
33340757NYMDFamily Nurse Practitioner
101.0114340VTMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Bend Memorial Clinic PC CurrentSince Aug 1, 2025 Accepting new patients
Signify Health Medical Associates, PLLC CurrentSince May 24, 2023 Accepting new patients
Schweiger Dermatology PLLC CurrentSince Aug 9, 2021 Accepting new patients
Bend Memorial Clinic PC Family CurrentSince Aug 1, 2025 Accepting new patients

Locations

333 Hooper Rd
Endwell, NY 13760
Phone (607) 729-2776

1501 NE Medical Center Dr
Bend, OR 97701
Phone (541) 317-4354

815 SW Bond St
#100
Bend, OR 97702
Phone (541) 706-2525

815 SW Bond St
Bend, OR 97702
Phone (541) 382-4900

780 Commercial St SE
Ste 100
Salem, OR 97301
Phone (469) 466-7037

4055 Valley View Ln
Ste 400
Dallas, TX 75244
Phone (469) 466-7037

Organizations & group practices 4

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 2

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": "1439251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630368000000",
    "number": "1871969022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1517",
            "city": "PENDLETON",
            "state": "OR",
            "postal_code": "978010410",
            "telephone_number": "877-708-1119",
            "fax_number": "541-278-8349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2195 NW SHEVLIN PARK RD STE 100",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977037102",
            "telephone_number": "541-706-3819",
            "fax_number": "541-429-6659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EHNTHOLT",
        "first_name": "ABBY",
        "name_prefix": "Ms.",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-08-11",
        "last_updated": "2021-08-31",
        "certification_date": "2021-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "VT",
            "license": "101.0114340",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "33340757",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bend, OR

Sources for this page

Verify at the official NPI Registry.