NPIMap

Organization Active NPI

Sage Adult and Geriatric Primary Care LLC

  • Gerontology Nurse Practitioner
  • The Dalles, OR
National Provider Identifier
1932642568
Registry record updated Nov 30, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
200150060NP Issued in OR
Legal business name
SAGE ADULT AND GERIATRIC PRIMARY CARE LLC
Practice address
1015 Webber St Ste 100
The Dalles, OR 97058-3527
Phone
(541) 296-4804
Fax
(541) 296-3741
NPI assigned
Nov 30, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2016

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

Authorized official

Name
Ms. Nina Van Es, ANP/GNPNPI 1750359790
Title
Owner
Phone
(541) 296-4804

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LA2200X 200150061NP OR
Gerontology Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LG0600X 200150060NP OR Primary

Addresses

Primary practice location

1015 Webber St Ste 100
The Dalles, OR 97058-3527

Mailing address

1015 Webber St Ste 100
The Dalles, OR 97058-3527
Phone (541) 296-4804

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1480464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480464000000",
    "number": "1932642568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1015 WEBBER ST STE 100",
            "city": "THE DALLES",
            "state": "OR",
            "postal_code": "970583527",
            "telephone_number": "541-296-4804",
            "fax_number": "541-296-3741"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1015 WEBBER ST STE 100",
            "city": "THE DALLES",
            "state": "OR",
            "postal_code": "970583527",
            "telephone_number": "541-296-4804",
            "fax_number": "541-296-3741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAGE ADULT AND GERIATRIC PRIMARY CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-30",
        "last_updated": "2016-11-30",
        "status": "A",
        "authorized_official_last_name": "VAN ES",
        "authorized_official_first_name": "NINA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "541-296-4804",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "ANP/GNP"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "OR",
            "license": "200150061NP",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "OR",
            "license": "200150060NP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in The Dalles, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 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.