Agatha Song

Primary specialty

SpecialistTaxonomy code 174400000X

License

25MA04557700 Issued in NJ

Practice address

913 NW Garden Valley Blvd
Roseburg, OR 97470-6523

Phone

(541) 440-1377

Fax

(541) 440-1394

NPI assigned

Apr 26, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• A Sulse M. D. Prof Assoc

  • Specialist
  • Woodbridge, NJ
  • NPI 1124279252
  NPD (past)
• Johnson Chiropractic Health and Wellness Center PLLC

  • Health Maintenance Organization
  • Guymon, OK
  • NPI 1144429945
  NPD (past)

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

{
    "created_epoch": "1177545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1992925507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1450 NW MULHOLLAND DR",
            "address_2": "# 156",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974701942",
            "telephone_number": "620-802-1220",
            "fax_number": "541-673-0901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "913 NW GARDEN VALLEY BLVD",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974706523",
            "telephone_number": "541-440-1377",
            "fax_number": "541-440-1394"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SONG",
        "first_name": "AGATHA",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NJ",
            "license": "25MA04557700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brent L Soder, M.D.
• David Kent Soder, DDS
• Eric A Soder, MD
• Carmela Rosa Solimine
• Adam Solomon, NURSE PRACTITIONER
• Sonus-USA, Inc.
• Shawn Sorensen, CSWA, QMHP, CADCIII
• Thomas Wayne Sorrells Jr., CSWA
• Soul Sessions Psychotherapy LLC
• James William Southam, NP-C, FNP

• Specialist in Roseburg, OR
• Providers in Roseburg, OR by specialty
• Specialist in Oregon

• 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.
• 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.