Active NPI
Diane Wadiak Backus, PH.D.
- Clinical Psychologist
- Bend, OR
National Provider Identifier
1942341847
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 1468
- Practice address
- 1012 SW Emkay Dr
Bend, OR 97702-1010 - Phone
- (541) 617-0024
- NPI assigned
- Feb 12, 2007
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 1468 | OR | Primary |
Addresses
Primary practice location
1012 SW Emkay Dr
Bend, OR 97702-1010
Mailing address
1012 SW Emkay Dr
Bend, OR 97702-1010
Phone (541) 617-0024
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 808489000 | Other | OR | REGENCE BLUE CROSS BLUE S |
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1468 | OR | MD | Naturopath |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171238400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1942341847",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1012 SW EMKAY DR",
"city": "BEND",
"state": "OR",
"postal_code": "977021010",
"telephone_number": "541-617-0024"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1012 SW EMKAY DR",
"city": "BEND",
"state": "OR",
"postal_code": "977021010",
"telephone_number": "541-617-0024"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BACKUS",
"first_name": "DIANE",
"middle_name": "WADIAK",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-02-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OR",
"license": "1468",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE BLUE CROSS BLUE S",
"identifier": "808489000",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bend, 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.