Laurie Dutkiewicz, D.O

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

DO153852 Issued in OR

Practice address

965 Ellendale Dr
Medford, OR 97504-8215

Phone

(541) 734-3430

Fax

(541) 734-3638

NPI assigned

May 7, 2007

Sex

Female

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 1

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Merit-based Incentive Payment System (MIPS)

Final score

96.05 of 100Reported as group

Quality

96.63

Promoting interoperability

100

Improvement activities

40

Cost

79.14

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Providence Health & Services - Oregon

  dba Providence Medford Medical Center

  • Clinic/Center
  • Medford, OR
  • NPI 1093976243
  Medicare reassignment NPD
• Providence Health & Services - Oregon

  dba Providence Medford Medical Center

  • Clinical Pathology Physician
  • Medford, OR
  • NPI 1285185942

  Internal Medicine

  NPD
• Emgi - Riley, LLC

  • Emergency Medicine Physician
  • Indianapolis, IN
  • NPI 1720020381
  NPD (past)
• Emgi - University, LLC

  • Emergency Medical Services (Emergency Medicine) Physician
  • Indianapolis, IN
  • NPI 1508808783
  NPD (past)
• Icem-University-Riley, LLC

  • Emergency Medicine Physician
  • Indianapolis, IN
  • NPI 1417284563
  NPD (past)
• Icem, LLC

  • Emergency Medicine Physician
  • Indianapolis, IN
  • NPI 1467788208
  NPD (past)

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

{
    "created_epoch": "1178496000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600905600000",
    "number": "1952514143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3158",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083158",
            "telephone_number": "541-734-3430",
            "fax_number": "541-734-3638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "965 ELLENDALE DR",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975048215",
            "telephone_number": "541-734-3430",
            "fax_number": "541-734-3638"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUTKIEWICZ",
        "first_name": "LAURIE",
        "name_prefix": "Dr.",
        "credential": "D.O",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-07",
        "last_updated": "2020-09-24",
        "certification_date": "2020-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "DO153852",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500637941",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ldutkiewicz126776@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "3225 Hillcrest Park Dr",
            "city": "Medford",
            "state": "OR",
            "country_code": "US",
            "postal_code": "975047657",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ldutkiewicz126776@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "70 Bower Dr",
            "city": "Medford",
            "state": "OR",
            "country_code": "US",
            "postal_code": "975013689",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Donald Lee Durett
• Rebekah Virginia Lavonne Durham, LMT
• Cindy Duron
• Michael Uchechukwu Duru
• Megan Dussault, OTR/L
• Radek M Dutkiewicz, MD
• Terces Dutton
• Calley Duvall, QMHA
• Heather Monique Duvall, CADC-R
• Mariah April Dawn Duvall

• Internal Medicine Physician in Medford, OR
• Providers in Medford, OR by specialty
• Internal Medicine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.