CRATER LAKE MEDICAL SOUTH
NPI 1447752035
Nurse Practitioner - Family in Shady Cove, OR
NPI Status: Active since February 28, 2018
Contact Information
21990 HIGHWAY 62
SHADY COVE, OR
ZIP 97539
Phone: (541) 878-2022
Fax: (541) 878-1498
- Organization
- Nurse Practitioner
- Family
- Accepts Insurance
- CLIA Number: 38D0628068
- CLIA Cert. Type: Practitioner Other
- CLIA Exp. Date: 12-21-2026
About CRATER LAKE MEDICAL SOUTH
This page provides the complete NPI Profile along with additional information for Crater Lake Medical South, a provider established in Shady Cove, Oregon operating as a Nurse Practitioner, focusing in family . The healthcare provider is registered in the NPI registry with number 1447752035 assigned on February 2018. The practitioner's primary taxonomy code is 363LF0000X with license number 201050002NP (OR). The provider is registered as an organization and their NPI record was last updated 2 years ago. The organization operates as a Single Specialty Group with one or more individual practitioners, all of who practice with the same area of specialization. The provider's is doing business as Crater Lake Medical South. The authorized official of this NPI record is Mrs. Laura Lynn Johnson Np-c (Nurse Practitioner)
- NPI
- 1447752035
- Provider Legal Name
- LAURA L. JOHNSON, N.P., P.C.
- Other Organization Name
- CRATER LAKE MEDICAL SOUTH
- Other Name Type
- Doing Business As (3)
- Entity Type
- Organization
- Location Address
- 21990 HIGHWAY 62 SHADY COVE, OR 97539
- Location Phone
- (541) 878-2022
- Location Fax
- (541) 878-1498
- Mailing Address
- PO BOX 508 SHADY COVE, OR 97539
- Mailing Phone
- (541) 878-2022
- Mailing Fax
- (541) 878-1498
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 02-28-2018
- Last Update Date
- 06-25-2024
- Code Navigator
A nurse practitioner (NP) like Crater Lake Medical South is an experienced registered nurse with a master’s or doctoral degree and advanced clinical training. Nurse practitioners can work in many different specialties including primary care, pediatrics, cardiology, emergency, women’s health, oncology or geriatrics. Nurse practitioners provide services like physical exams, order laboratory tests, manage diseases, write prescriptions, etc.
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Nurse Practitioner Family
- Taxonomy Code
- 363LF0000X
- Type
- Physician Assistants & Advanced Practice Nursing Providers
- License No.
- 201050002NP
- License State
- OR
Group Taxonomy 193400000X SINGLE SPECIALTY GROUP
This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- BridgeSpan Standard Bronze Plan - EPO
- BridgeSpan Standard Gold Plan - EPO
- BridgeSpan Standard Silver Plan - EPO
- Moda Health Affinity Bronze 8000 - EPO
- Moda Health Affinity Bronze 9000 - EPO
- Moda Health Affinity Bronze HDHP 7500 - EPO
- Moda Health Affinity Gold 1000 - EPO
- Moda Health Affinity Gold 1500 - EPO
- Moda Health Affinity Gold 250 - EPO
- Moda Health Affinity Silver 3000 - EPO
- Moda Health Affinity Silver 3400 - EPO
- Moda Health Affinity Silver 4500 - EPO
- Moda Health Affinity Silver 6000 - EPO
- Moda Health Oregon Standard Bronze Affinity - EPO
- Moda Health Oregon Standard Gold Affinity - EPO
- Moda Health Oregon Standard Silver Affinity - EPO
- Bronze 8000 Individual Connect - EPO
- Bronze Essential 9000 With 4 Copay No Deductible Office Visits Individual Connect - EPO
- Bronze HSA 7000 Individual Connect - EPO
- Gold 2300 Individual Connect - EPO
- Regence Standard Bronze Plan Individual Connect - EPO
- Regence Standard Gold Plan Individual Connect - EPO
- Regence Standard Silver Plan Individual Connect - EPO
- Silver 6500 Individual Connect - EPO
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 500616623 | MEDICAID (05) | OR |
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 38D0628068
- Facility Type
- Practitioner Other
- Certificate Effective Date
- December 22, 2024
- Certificate Expiration Date
- December 21, 2026
- Laboratory Director
- LAURA L. SUTHERLAND
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Crater Lake Medical South to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1447752035, we treat the final digit (5) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 65. The final step is to find the difference between that total and the next multiple of ten (70 - 65 = 5).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 65 is 70. The difference is the calculated check digit.
Other Providers at the Same Location
The following 2 providers are registered at the same or a nearby location.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1447752035, enumerated as an "organization" on February 28, 2018.
The provider is located at 21990 HIGHWAY 62 SHADY COVE, OR 97539 and the phone number is (541) 878-2022.
Nurse Practitioner with taxonomy code 363LF0000X and a focus in Family.
The provider might be accepting Accepts: BridgeSpan Health Company, Moda Health Plan, Inc.,. Please consult your insurance carrier or call the provider to verify.
