OrganizationActive
Providence Health & Services - Oregon
NPI 1063705887 · Internal Medicine Physician · Medford, OR
Provider details
- NPI number
- 1063705887
- Entity type
- Organization
- Primary specialty
- Internal Medicine PhysicianAllopathic & Osteopathic Physicians
- Parent organization
- Providence Health & Services - Oregon
- Organization subpart
- Yes
- Authorized official
- Donald Anderson, Assistant Secretary Enrollment(425) 358-9786
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
Detailed profile(81/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
15 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
920 Royal Ave
Medford, OR 97504-6169
Phone: (541) 732-8400
Fax: (541) 732-8401
Street-level locationGet directions
Mailing address
Po Box 31001 - 4180
Pasadena, CA 91110-4180
Other names (DBA / former)
- Doing business as
- Pmg Medford Physiatry
- Doing business as
- Pmg Medford Physiatry
- Doing business as
- Pmg South Medford Neurology
- Doing business as
- Providence Medical Group South
Registry dates
- Enumerated
- 2011-05-26
- Last updated
- 2025-11-19
- Certified
- 2025-11-19
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.