Active NPI
Ralph Emmanuel Taguba, PA-C
- Federally Qualified Health Center (FQHC)
- Klamath Falls, OR
National Provider Identifier
1881164739
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Federally Qualified Health Center (FQHC)
- Practice address
- 2074 S 6TH St
Klamath Falls, OR 97601-3372 - Phone
- (541) 851-8110
- NPI assigned
- Dec 4, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA191687 | OR | |
| Physician Assistant | 363A00000X | 1158708 | NV | |
| Federally Qualified Health Center (FQHC) | 261QF0400X | Primary |
Addresses
Primary practice location
2074 S 6TH St
Klamath Falls, OR 97601-3372
Mailing address
2074 S 6TH St
Klamath Falls, OR 97601-3372
Phone (541) 851-8110
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 170061 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
10 Coburg Rd
Suite 201
Eugene, OR 97401-7487
Phone (541) 687-8581
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1158708 | NV | MD | Physician Assistant |
| PA191687 | OR | MD | Physician Assistant |
Organizations & group practices 1
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": "1543881600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1575936000000",
"number": "1881164739",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2074 S 6TH ST",
"city": "KLAMATH FALLS",
"state": "OR",
"postal_code": "976013372",
"telephone_number": "541-851-8110"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2074 S 6TH ST",
"city": "KLAMATH FALLS",
"state": "OR",
"postal_code": "976013372",
"telephone_number": "541-851-8110"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TAGUBA",
"first_name": "RALPH",
"middle_name": "EMMANUEL",
"name_prefix": "Mr.",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-12-04",
"last_updated": "2019-12-10",
"certification_date": "2019-12-10",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "OR",
"license": "PA191687",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NV",
"license": "1158708",
"primary": false
},
{
"code": "261QF0400X",
"taxonomy_group": "",
"desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "170061",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Klamath Falls, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.