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DIANE BOLDUC M.D. NPI 1174537047


NPI Information

NPI: 1174537047
Provider Name: DIANE BOLDUC, M.D.
Classification: Family Medicine - 207Q00000X
Entity Type: Individual

PECOS Registration: Yes

CLIA Number: 38D1015662

Address:
340 MEDICAL LOOP
ROSEBURG, OR
ZIP 97470
Phone: (541) 464-5907
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Diane Bolduc, M.D. is a family medicine in Roseburg, OR with 25 years of experience. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. Diane Bolduc, M.D. NPI is 1174537047. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

340 MEDICAL LOOP
ROSEBURG, OR
ZIP 97470-645
Phone: (541) 464-5907
Fax: (541) 464-8481

The NPI 1174537047 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The CLIA number assigned to this NPI record is 38D1015662 - physician office with a certificate type of Certificate of Waiver.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit (HCPCS:G0439)
  • Urinalysis, manual test (HCPCS:81002)

The enumeration date for this NPI number is 7/28/2006 and was last updated on 7/9/2007.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily MedicineMD23487OREGONYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1PINP00173518MEDICARE ID-TYPE UNSPECIFIEDRAILROAD MEDICARE
2J103601OTHEROREGONPACIFIC SOURCE
3119657MEDICARE PINOREGON
4287185MEDICAIDOREGON
5H54388MEDICARE UPINOREGON
632945700000OTHERPROVIDENCE HEALTH PLANS
7608828900OTHERBLACK LUNG FEDERAL PROGRA
8840254000OTHEROREGONREGENCE BLUE CROSS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.