Robert C Quackenbush, M.D.

Primary specialty

Medical Oncology PhysicianTaxonomy code 207RX0202X

License

MD00039975 Issued in WA

Practice address

401 W Poplar St
Walla Walla, WA 99362-2846

Phone

(509) 522-5700

Fax

(509) 522-5705

NPI assigned

May 25, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 4

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Commonspirit Oregon

  • Surgery Physician
  • Roseburg, OR
  • NPI 1215106133
  Medicare reassignment
• Robert Quackenbush MD PLLC

  • Specialist
  • Walla Walla, WA
  • NPI 1043404163
  NPD (past) Authorized official
• Commonspirit Oregon

  • Rural Health Clinic/Center
  • Pendleton, OR
  • NPI 1780880518
  NPD (past)
• Ut Physicians

  • Anesthesiology Physician
  • Houston, TX
  • NPI 1033157821
  NPD (past)
• Ut Physicians

  • Health Educator
  • Houston, TX
  • NPI 1316534472
  NPD (past)

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

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1372204800000",
    "number": "1962458877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 32",
            "city": "LIBERTY LAKE",
            "state": "WA",
            "postal_code": "990190032",
            "telephone_number": "509-522-5700",
            "fax_number": "509-522-5705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 W POPLAR ST",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993622846",
            "telephone_number": "509-522-5700",
            "fax_number": "509-522-5705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "QUACKENBUSH",
        "first_name": "ROBERT",
        "middle_name": "C",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-25",
        "last_updated": "2013-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "WA",
            "license": "MD00039975",
            "primary": false
        },
        {
            "code": "207RX0202X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Medical Oncology",
            "state": "WA",
            "license": "MD00039975",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RRMC",
            "identifier": "P00057996",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "227516",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8060599",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1118421",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Providence Health & Services - Washington
• Jeffrey M Pryor, D.O.
• Estee E Pummel, LSWAIC
• Sheena Pursley, MSW, LSWAIC
• Judy Quach, OD
• Qualicenters Inland Northwest L.L.C.
• Dana Rabourne
• Judith Raboy, NP
• Alissa N Ralston, ARNP
• Trina Jean Ralston, RN00127773

• Medical Oncology Physician in Walla Walla, WA
• Providers in Walla Walla, WA by specialty
• Medical Oncology Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2013; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.