Individual provider Active NPI

Amanda M Bujaucius, CNM

  • Advanced Practice Midwife
  • Medford, OR
National Provider Identifier
1891205134
Registry record updated Mar 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Advanced Practice MidwifeTaxonomy code 367A00000X
License
10001858 Issued in OR
Practice address
940 Royal Ave Unit 350
Medford, OR 97504-6194
Phone
(541) 732-7460
NPI assigned
Sep 30, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X AP10643 AZ
Advanced Practice Midwife 367A00000X 10001858 OR Primary

Addresses

Primary practice location

940 Royal Ave Unit 350
Medford, OR 97504-6194

Mailing address

PO Box 3158
Portland, OR 97208-3158
Phone (541) 732-7460

Other identifiers 1

IdentifierTypeStateIssuer
500815614MedicaidOR

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230215001079 OR Practitioner - Certified Nurse Midwife (CNM) 4789940529 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Nurse Midwife (CNM)
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Providence Health and Services OregonGroup PAC ID 5294623245, 166 clinicians

Practice addresses (Care Compare)

940 Royal Ave
Unit 350
Medford, OR 97504-6194
Phone (541) 732-7460

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Midwife

State licenses

LicenseStateTypeSpecialty
AP10643AZMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services - Oregon Current Accepting new patients
Providence Health & Services - Oregon CurrentSince Feb 6, 2023 Accepting new patients
Providence Health & Services Oregon Current Accepting new patients
Providence Health & Services - Oregon Obstetrics & Gynecology CurrentSince Feb 6, 2023 Accepting new patients
Providence Health & Services - Oregon CurrentSince Feb 6, 2023 Accepting new patients
Providence Health & Services - Oregon CurrentSince Feb 6, 2023 Accepting new patients

Locations

940 Royal Ave
Unit 350
Medford, OR 97504
Phone (541) 732-7460

1111 Crater Lake Ave
Medford, OR 97504
Phone (541) 732-5250

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1506729600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680220800000",
    "number": "1891205134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3158",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083158",
            "telephone_number": "541-732-7460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "940 ROYAL AVE UNIT 350",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975046194",
            "telephone_number": "541-732-7460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUJAUCIUS",
        "first_name": "AMANDA",
        "middle_name": "M",
        "credential": "CNM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-30",
        "last_updated": "2023-03-31",
        "certification_date": "2023-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "AZ",
            "license": "AP10643",
            "primary": false
        },
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "OR",
            "license": "10001858",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500815614",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Medford, OR

Sources for this page

Verify at the official NPI Registry.