Individual provider Active NPI

Rebecca McKay Mueller, M.D.

  • Pediatrics Physician
  • Medford, OR
National Provider Identifier
1902048580
Registry record updated Jan 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
MD178887 Issued in OR
Practice address
1307 W Main St
Medford, OR 97501-2936
Phone
(541) 535-6239
NPI assigned
Mar 30, 2009
Last updated
Jan 10, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X MD178887 OR Primary

Addresses

Primary practice location

1307 W Main St
Medford, OR 97501-2936

Mailing address

931 Chevy Way
Medford, OR 97504-4127

Other practice location 1

638 Market St
Medford, OR 97504-6126
Phone (541) 535-6239

Other identifiers 1

IdentifierTypeStateIssuer
500712606MedicaidOR

Other names 1

  • Mrs. Rebecca McKay Lietzow Former name

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160822002101 OR Practitioner - Pediatric Medicine 9133398571 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD178887ORMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
La Clinica del Valle Family Health Care Center Inc. CurrentSince Jan 27, 2025 Accepting new patients
La Clinica del Valle Family Health Care Center Inc. CurrentSince Jan 27, 2025 Accepting new patients

Locations

1307 W Main St
Medford, OR 97501
Phone (541) 618-1314

3617 S Pacific Hwy
Medford, OR 97501
Phone (541) 512-3182

638 Market St
Medford, OR 97504
Phone (541) 494-3840

931 Chevy Way
Medford, OR 97504
Phone (541) 690-3555

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, 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": "1238371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736467200000",
    "number": "1902048580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "931 CHEVY WAY",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975044127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1307 W MAIN ST",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975012936",
            "telephone_number": "541-535-6239"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "638 Market St",
            "address_purpose": "LOCATION",
            "city": "Medford",
            "state": "OR",
            "postal_code": "975046126",
            "country_code": "US",
            "telephone_number": "541-535-6239",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MUELLER",
        "first_name": "REBECCA",
        "middle_name": "MCKAY",
        "name_prefix": "Mrs.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-03-30",
        "last_updated": "2025-01-10",
        "certification_date": "2025-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OR",
            "license": "MD178887",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500712606",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "REBECCA",
            "last_name": "LIETZOW",
            "middle_name": "MCKAY",
            "prefix": "MRS.",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Medford, OR

Sources for this page

Verify at the official NPI Registry.