STACI BRYAN (NPI# 1396126942) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396126942 |
| Entity Type | Individual |
| Full Name | STACI BRYAN |
| Practice Address |
2700 Stewart Parkway Annex B Roseburg OR 97471 |
| Mailing Address |
272 Medical Loop Suite E Roseburg OR 97471 |
| Practice Telephone | 5414403532 |
| Practice Fax Number | 5414403554 |
| Mailing Telephone | 5414403532 |
| Mailing Fax Number | 5414403554 |
| Enumeration Date | 2015-06-09 |
| Last Update Date | 2015-06-09 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 171M00000X | Case Manager/Care Coordinator | Other Service Providers |
| Street Address |
2700 STEWART PARKWAY ANNEX B |
| City | ROSEBURG |
| State | OR |
| Zip Code | 97471 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235174004 | Jerry Robert Smead | Pharmacist | 2700 Stewart Parkway, Roseburg, OR 97471 | 2006-06-17 |
| 1568980407 | Rachel Sutton | Dental Hygienist | 2700 Stewart Parkway, Roseburg, OR 97471 | 2017-08-30 |
| 1467987388 | Toryn Clark | Community Health Worker | 2700 Stewart Parkway, Roseburg, OREGON 97470 | 2017-04-28 |
| 1376905273 | Lisa Dawn Disante | Community Health Worker | 2700 Stewart Parkway, Annex B, Roseburg, OR 97471 | 2016-03-22 |
| 1598125346 | Mary Anne Worthington | Counselor | 2700 Stewart Parkway, Annex B, Roseburg, OR 97471 | 2016-03-07 |
| 1598130858 | Michael Dale Shipley | Case Manager/Care Coordinator | 2700 Stewart Parkway, Annex B, Roseburg, OR 97471 | 2015-12-11 |
| 1023480548 | Angela Marie Gross | Case Manager/Care Coordinator | 2700 Stewart Parkway, Annex B, Roseburg, OR 97471 | 2015-10-23 |
| 1578945804 | Rebecca Potuzak | Case Manager/Care Coordinator | 2700 Stewart Parkway, Annex B, Roseburg, OR 97471 | 2015-06-23 |
| 1245610435 | Loriann Barber | Case Manager/Care Coordinator | 2700 Stewart Parkway, Annex B, Roseburg, OR 97471 | 2015-06-03 |
| 1144614553 | Imeya Raye Huntley | Case Manager/Care Coordinator | 2700 Stewart Parkway, Annex B, Roseburg, OR 97471 | 2015-03-24 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841805660 | Rae Ann Barnes | Pharmacist | 913 Ne Garden Valley Blvd, Pharmacy, Roseburg, OR 97471 | 2020-09-09 |
| 1023651031 | Colton Phillips | Behavioral Analyst | 940 Nw Garden Valley Bvld #104, Roseburg, OR 97471 | 2019-10-22 |
| 1952884876 | Meredith Krugel Lcsw PC | Clinic/Center | 2225 Nw Stewart Parkway Ste 200, Roseburg, OR 97471 | 2018-09-07 |
| 1114456563 | Philip Kaser Family, LLC | Pharmacy | 1175 W. Harvard Avenue, Roseburg, OR 97471 | 2017-06-08 |
| 1053854208 | Icco LLC | Clinic/Center | 1740 Nw Goetz Street, Roseburg, OR 97471 | 2016-11-21 |
| 1770034589 | Evie Jepsen | Case Manager/Care Coordinator | 2700 Stewart Parkway Annex B, Suite 110, Roseburg, OR 97471 | 2016-10-17 |
| 1932551256 | Jonathan Schmidt | Licensed Practical Nurse | 913 Nm Garden Valley Blvd, Va Roseburg Medical Center, Roseburg, OR 97471 | 2016-07-11 |
| 1932580586 | Jeffrey Mark Wareham | Case Manager/Care Coordinator | 2700 Medical Loop, Annex B, Roseburg, OR 97471 | 2015-06-09 |
| 1558784215 | Ginger Jean Thibedeau | Massage Therapist | 3019 Nw Stewart Parkway, Suite 304 #183, Roseburg, OR 97471 | 2014-01-30 |
| 1427303122 | Karishma Parekh | Internal Medicine | 2460 Nw Stewart Pkwy Ste 103, Roseburg, OR 97471 | 2012-07-18 |
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| Taxonomy Code | 171M00000X |
| Grouping | Other Service Providers |
| Classification | Case Manager/Care Coordinator |
| A person who provides case management services and assists an individual in gaining access to needed medical, social, educational, and/or other services. The person has the ability to provide an assessment and review of completed plan of care on a periodic basis. This person is also able to take collaborative action to coordinate the services with other providers and monitor the enrollee’s progress toward the cost-effective achievement of objectives specified in the plan of care. Credentials may vary from an experience in the fields of psychology, social work, rehabilitation, nursing or a closely related human service field, to a related Assoc of Arts Degree or to nursing credentials. Some states may require certification in case management. |
| Notes: Source: CMS State Medicaid Manual Section 4442.3 [7/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770034589 | Evie Jepsen | Case Manager/Care Coordinator | 2700 Stewart Parkway Annex B, Suite 110, Roseburg, OR 97471 | 2016-10-17 |
| 1932580586 | Jeffrey Mark Wareham | Case Manager/Care Coordinator | 2700 Medical Loop, Annex B, Roseburg, OR 97471 | 2015-06-09 |
| 1215040175 | Patricia Ann Taylor | Case Manager/Care Coordinator | 337 Se Fowler St, Roseburg, OR 97470-4348 | 2006-08-16 |
| 1194322396 | Christopher Hudgeon | Case Manager/Care Coordinator | 548 Se Jackson St, Roseburg, OR 97470-4983 | 2020-10-01 |
| 1538775754 | Aurora Petterson | Case Manager/Care Coordinator | 621 W Madrone St, Roseburg, OR 97470-3090 | 2020-09-22 |
| 1265040018 | Angelica Laurent | Case Manager/Care Coordinator | 621 W Madrone St, Roseburg, OR 97470-3090 | 2020-07-17 |
| 1770101719 | Travis Mcdowell | Case Manager/Care Coordinator | 283 Se Fowler St Ste 2, Roseburg, OR 97470-3309 | 2020-07-07 |
| 1417574898 | Bryn Orr | Case Manager/Care Coordinator | 621 W Madrone St, Roseburg, OR 97470-3090 | 2020-07-01 |
| 1689298754 | Cindy Walls | Case Manager/Care Coordinator | 621 W Madrone St, Roseburg, OR 97470-3090 | 2020-06-03 |
| 1144849589 | Larry Dale Clark | Case Manager/Care Coordinator | 621 W Madrone St, Roseburg, OR 97470-3090 | 2020-04-15 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.