Individual provider Active NPI

Jill A Antoine, MD

  • Anesthesiology Physician
  • Medford, OR
National Provider Identifier
1912963679
Registry record updated Nov 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
MD192745 Issued in OR
Practice address
1093 Royal CT
Medford, OR 97504-6130
Phone
(541) 773-7273
Fax
(541) 773-2027
NPI assigned
Apr 21, 2006
Last updated
Nov 18, 2019By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 18, 2019

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X G85473 CA
Anesthesiology Physician 207L00000X 218621 MA
Anesthesiology Physician 207L00000X MD192745 OR Primary

Addresses

Primary practice location

1093 Royal CT
Medford, OR 97504-6130

Mailing address

PO Box 1705
Medford, OR 97501-0132
Phone (541) 773-7273

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
218621MAMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Par Anesthesiology Medical Corporation Anesthesiology Past Accepting new patients
Empire Anesthesia Inc Anesthesiology PastSince Apr 16, 2008 Accepting new patients
Allen Lavee MD, Inc. Anesthesiology Past Accepting new patients
University Anesthesia Medical Group Anesthesiology Past Accepting new patients
Soma Anesthesia Medical Group Inc Past Accepting new patients
Active Health Chiropractic, PC PastSince Nov 24, 2019 Accepting new patients

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, 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": "1145577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574035200000",
    "number": "1912963679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1705",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975010132",
            "telephone_number": "541-773-7273",
            "fax_number": "541-773-2027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1093 ROYAL CT",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975046130",
            "telephone_number": "541-773-7273",
            "fax_number": "541-773-2027"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANTOINE",
        "first_name": "JILL",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-04-21",
        "last_updated": "2019-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CA",
            "license": "G85473",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MA",
            "license": "218621",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "OR",
            "license": "MD192745",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Medford, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2019; 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.