Active NPI
Michelle Jeanne Buncke
- Family Medicine Physician
- Portland, OR
National Provider Identifier
1881274249
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- STUDENT
- Practice address
- 3181 SW Sam Jackson Park Rd
Portland, OR 97239-3011 - Phone
- (111) 111-1111
- NPI assigned
- Apr 10, 2021
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | STUDENT | OR | Primary |
Addresses
Primary practice location
3181 SW Sam Jackson Park Rd
Portland, OR 97239-3011
Mailing address
1033 SW Gibbs St Unit 302
Portland, OR 97239-7327
Phone (503) 680-0173
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: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230718003769 | OR | Order and Referring Only - Otolaryngology | 5193185494 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| STUDENT | OR | MD | Naturopath |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1618012800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1618012800000",
"number": "1881274249",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1033 SW GIBBS ST UNIT 302",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972397327",
"telephone_number": "503-680-0173"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3181 SW SAM JACKSON PARK RD",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972393011",
"telephone_number": "111-111-1111"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUNCKE",
"first_name": "MICHELLE",
"middle_name": "JEANNE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-04-10",
"last_updated": "2021-04-10",
"certification_date": "2021-04-10",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "OR",
"license": "STUDENT",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2021; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.