Active NPI
Jack R Elvin, DENTURIST
- Denturist
- Albany, OR
National Provider Identifier
1932259397
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Denturist
- License
- DT-DO-609564
- Practice address
- 1113 Hill St SE
Albany, OR 97322-3295 - Phone
- (541) 928-1955
- NPI assigned
- Jan 10, 2007
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Denturist | 122400000X | DT-DO-609564 | OR | Primary |
Addresses
Primary practice location
1113 Hill St SE
Albany, OR 97322-3295
Mailing address
1645 9TH Ave SE
#286
Albany, OR 97322-4872
Phone (541) 928-1955
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 071696 | Medicaid | OR |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DT-DO-609564 | OR | MD | Denturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168387200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1932259397",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1645 9TH AVE SE",
"address_2": "#286",
"city": "ALBANY",
"state": "OR",
"postal_code": "973224872",
"telephone_number": "541-928-1955"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1113 HILL ST SE",
"city": "ALBANY",
"state": "OR",
"postal_code": "973223295",
"telephone_number": "541-928-1955"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELVIN",
"first_name": "JACK",
"middle_name": "R",
"credential": "DENTURIST",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-10",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122400000X",
"taxonomy_group": "",
"desc": "Denturist",
"state": "OR",
"license": "DT-DO-609564",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "071696",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Albany, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.