Jonathan Wymore, RD, LD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

LDD10175002 Issued in OR

Practice address

620 Elm St SW # 2
Albany, OR 97321-1986

Phone

(541) 812-4839

NPI assigned

Nov 8, 2016

Last updated

Nov 8, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Jonathan Douglas Wymore Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Samaritan Health Services

  • Health Service Clinic/Center
  • Albany, OR
  • NPI 1114469103
  NPD (past) Authorized official

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

{
    "created_epoch": "1478563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1478563200000",
    "number": "1912449919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 ELM ST SW # 2",
            "city": "ALBANY",
            "state": "OR",
            "postal_code": "973211986",
            "telephone_number": "541-812-4839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 ELM ST SW # 2",
            "city": "ALBANY",
            "state": "OR",
            "postal_code": "973211986",
            "telephone_number": "541-812-4839"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYMORE",
        "first_name": "JONATHAN",
        "name_prefix": "Mr.",
        "credential": "RD, LD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-11-08",
        "last_updated": "2016-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "OR",
            "license": "LDD10175002",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OREGON DIETETIC LICENSURE",
            "identifier": "LDD10175002",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMMISION ON DIETETIC REGISTRATION",
            "identifier": "86065504",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JONATHAN",
            "last_name": "WYMORE",
            "middle_name": "DOUGLAS",
            "credential": "RD, LD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• S Jon Woods, DMD
• Ross Wopat, M.D.
• Rodney L. Wren, M.D.
• Noblelee Dawn Wright
• Collin Andrew Wulff, DO (STUDENT)
• Susan X Xu-Wong, D.D.S.
• Alexandra Yam
• Brook Barrett Yetter
• Jonathan J Yoder, RPH
• Samantha York

• Registered Dietitian in Albany, OR
• Providers in Albany, OR by specialty
• Registered Dietitian in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.