Active NPI 1194162230 Individual Practitioner Male Practitioner

Dr. Matthew Ryan Clark , MD

Dermatology - MOHS-Micrographic Surgery • Bend, OR

✓ Accepts Medicare Assignment

Professional Overview & Biography Verified Profile Summary

Dr. Matthew Clark, MD is a certified Dermatology - MOHS-Micrographic Surgery practicing in Bend, OR. With approximately 13 years of clinical experience since graduating from University Of Florida College Of Medicine in 2013, Dr. Clark delivers high-quality medical care to the local community at 2353 NE CONNERS AVE.

Dr. Clark is affiliated with Dermatologic Surgery Of The Carolinas Llc and accepts Medicare assignment.

Frequently performed procedures and clinical services include removal and microscopic exam of growth of head, neck, hands, feet, or genitals, 1-5 tissue blocks, removal and microscopic exam of growth of head, neck, hands, feet, or genitals, new patient outpatient office visit. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

2353 Ne Conners Ave

Bend, OR 977016068

Telephone 5413237546

Associated Practice Facility / Clinic

🏢 Peters Dermatology Center Facility NPI 1871954214

Medicare Profile & Education

Medical School

University Of Florida College Of Medicine

Graduation Year

2013

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Dermatology - MOHS-Micrographic Surgery in Bend, OR

Established Specialist (10-20 Yrs)

Practitioner Clinical Experience

13 Yrs -12.0 yrs vs City Avg

City Avg: 25.0 Yrs

State Avg: 18.9 Yrs

Regional Practice Density

3 Specialists

Practicing in Bend, OR (23 Statewide)

Telehealth Adoption Rate

0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

61.8% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Clark (13 Years) 13 Yrs

Bend Specialty Average (25.0 Years) 25.0 Yrs

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2024)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17311 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, 1-5 tissue blocks	453	367	$1282.00	$543.60
17312 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, each additional stage, 1-5 tissue blocks	243	161	$774.00	$377.17
99202 New patient office or other outpatient visit, typically 20 minutes	141	141	$132.17	$66.69
12052 Repair of wound (2.6 to 5.0 centimeters) of face, ears, eyelids, nose, lips, and/or mouth	106	101	$521.00	$146.26
99213 Established patient office or other outpatient visit, typically 15 minutes	79	66	$146.52	$83.08
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	79	74	$642.00	$243.47
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	64	59	$1014.00	$226.97
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	55	55	$187.00	$102.65
J9190 Injection, fluorouracil, 500 mg	45	28	$100.00	$2.66
96405 Administration of chemotherapy into growth, 1-7	44	28	$160.00	$65.48
17313 Removal and microscopic exam of growth of trunk, arms, or legs, 1-5 tissue blocks	42	42	$1172.00	$580.00
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	40	39	$994.00	$210.15
14060 Repair of wound of eyelids, nose, ears, or lips by transferring skin, 10.0 sq cm or less	39	38	$1396.00	$700.94
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	34	34	$507.00	$126.18
13152 Complicated repair of wound of eyelids, nose, ears, or lip, 2.6-7.5 cm	31	31	$998.00	$228.94
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	28	28	$481.00	$112.91
11102 Tangential biopsy of single skin lesion	27	25	$550.00	$78.43
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	23	19	$187.00	$120.20
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	18	18	$287.00	$156.67
12042 Intermediate repair of wound of neck, hands, feet, or genitals, 2.6-7.5 cm	16	15	$606.00	$133.90
15260 Relocation of patient skin to nose, ears, eyelids, and/or lips (20 sq centimeters or less)	16	15	$1748.00	$925.27
14061 Repair of wound of eyelids, nose, ears, or lips by transferring skin, 10.1-30.0 sq cm	15	15	$2039.00	$894.64
12034 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 7.6-12.5 cm	15	15	$650.00	$204.65
12051 Intermediate repair of wound of face, ears, eyelids, nose, lips, or mouth, 2.5 cm or less	14	14	$472.00	$129.60
12053 Intermediate repair of wound of face, ears, eyelids, nose, lips, or mouth, 5.1-7.5 cm	13	13	$599.00	$179.36
14301 Repair of wound by transferring skin, 30.1-60.0 sq cm	12	12	$2500.00	$999.62
14041 Repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet by transferring skin, 10.1-30.0 sq cm	12	11	$1879.00	$854.58
13151 Complicated repair of wound of eyelids, nose, ears, or lip, 1.1-2.5 cm	11	11	$733.00	$193.38

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	494	90	$14.43	$6.50
99213 Established patient office or other outpatient visit, typically 15 minutes	167	150	$181.53	$86.37
17311 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, 1-5 tissue blocks	162	154	$1403.55	$568.47
17000 Destruction of skin growth	136	123	$166.47	$50.33
11102 Tangential biopsy of single skin lesion	113	108	$265.45	$90.91
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	103	103	$240.77	$106.43
17312 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, each additional stage, 1-5 tissue blocks	94	64	$830.29	$391.65
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	54	51	$708.13	$257.62
17110 Destruction of up to 14 skin growths	46	42	$282.00	$107.65
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	46	41	$269.92	$123.03
12052 Repair of wound (2.6 to 5.0 centimeters) of face, ears, eyelids, nose, lips, and/or mouth	40	40	$583.33	$150.91
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	30	30	$362.13	$159.71
11103 Biopsy of related skin growth, each additional growth	30	21	$172.44	$48.53
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	29	28	$529.13	$117.18
17004 Destruction of precancer skin growth, 15 or more growths	27	27	$388.33	$163.89
99202 New patient office or other outpatient visit, typically 20 minutes	22	22	$143.32	$69.06
17313 Removal and microscopic exam of growth of trunk, arms, or legs, 1-5 tissue blocks	19	18	$1396.86	$496.86
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	18	18	$1030.87	$215.05
J7308 Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg)	13	12	$1011.48	$384.93
14060 Repair of wound of eyelids, nose, ears, or lips by transferring skin, 10.0 sq cm or less	13	13	$1671.10	$679.10
96574 Application of light with debridement to destroy precancer skin growth	13	12	$653.20	$272.74
13152 Complicated repair of wound of eyelids, nose, ears, or lip, 2.6-7.5 cm	12	12	$1023.55	$237.40

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	619	106	$14.43	$6.64
99213 Established patient office or other outpatient visit, typically 15 minutes	169	131	$188.30	$87.78
17000 Destruction of skin growth	164	134	$166.68	$49.09
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	128	128	$265.00	$108.66
17311 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, 1-5 tissue blocks	126	105	$1710.05	$557.88
11102 Tangential biopsy of single skin lesion	117	109	$252.28	$94.38
17312 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, each additional stage, 1-5 tissue blocks	71	48	$1014.50	$400.69
17110 Destruction of up to 14 skin growths	58	52	$282.00	$108.85
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	42	35	$275.70	$122.93
11103 Biopsy of related skin growth, each additional growth	40	26	$136.05	$50.22
17004 Destruction of precancer skin growth, 15 or more growths	39	32	$388.33	$164.96
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	36	36	$385.00	$162.19
12052 Repair of wound (2.6 to 5.0 centimeters) of face, ears, eyelids, nose, lips, and/or mouth	34	33	$770.33	$169.15
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	30	29	$779.35	$238.32
96574 Application of light with debridement to destroy precancer skin growth	17	15	$653.20	$280.85
J7308 Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg)	17	15	$1011.48	$389.14
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	14	14	$451.40	$149.87
17313 Removal and microscopic exam of growth of trunk, arms, or legs, 1-5 tissue blocks	13	12	$1599.23	$543.87
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	11	11	$727.10	$136.38

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	414	80	$14.82	$6.43
11102 Tangential biopsy of single skin lesion	105	97	$252.28	$94.32
17311 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, 1-5 tissue blocks	104	85	$1768.70	$550.33
17000 Destruction of skin growth	101	91	$170.86	$50.18
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	98	98	$276.53	$108.24
99213 Established patient office or other outpatient visit, typically 15 minutes	86	72	$192.43	$89.24
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	54	49	$286.86	$124.99
17312 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, each additional stage, 1-5 tissue blocks	53	38	$1034.96	$396.72
11103 Biopsy of related skin growth, each additional growth	42	27	$136.05	$50.79
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	40	40	$423.20	$164.27
17110 Destruction of up to 14 skin growths	40	39	$287.05	$105.92
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	24	23	$115.70	$55.16
17004 Destruction of precancer skin growth, 15 or more growths	21	20	$388.33	$163.05
12052 Repair of wound (2.6 to 5.0 centimeters) of face, ears, eyelids, nose, lips, and/or mouth	20	20	$825.46	$171.78
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	17	17	$498.93	$160.04
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	17	17	$1230.73	$222.83
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	15	15	$797.86	$274.01
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	13	12	$1165.28	$231.02

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	438	85	$20.00	$5.91
17000 Destruction of skin growth	126	105	$227.00	$48.54
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	125	125	$348.00	$105.13
99213 Established patient office or other outpatient visit, typically 15 minutes	118	84	$239.00	$73.40
96900 Application of ultraviolet light to skin	92	11	$69.00	$21.64
11102 Tangential biopsy of single skin lesion	79	68	$343.00	$90.01
17311 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, 1-5 tissue blocks	78	67	$2320.00	$522.24
17312 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, each additional stage, 1-5 tissue blocks	47	30	$1376.00	$390.33
11103 Biopsy of related skin growth, each additional growth	38	21	$185.00	$51.98
99202 New patient office or other outpatient visit, typically 20 minutes	34	34	$246.00	$74.30
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	31	29	$351.00	$106.49
17110 Destruction of up to 14 skin growths	28	24	$383.00	$107.56
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	17	16	$1057.00	$261.27
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	16	11	$613.00	$135.73
14060 Repair of wound of eyelids, nose, ears, or lips by transferring skin, 10.0 sq cm or less	15	15	$2705.00	$682.16
12052 Repair of wound (2.6 to 5.0 centimeters) of face, ears, eyelids, nose, lips, and/or mouth	13	13	$1046.00	$161.05
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	12	12	$145.00	$44.36
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	11	11	$1670.00	$255.36

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17311 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, 1-5 tissue blocks	191	168	$969.43	$572.14
17003 Destruction of precancer skin growth, 2-14 growths	187	36	$13.68	$5.76
17312 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, each additional stage, 1-5 tissue blocks	115	83	$576.16	$401.98
99213 Established patient office or other outpatient visit, typically 15 minutes	70	57	$106.09	$75.05
17000 Destruction of skin growth	57	51	$96.00	$47.27
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	50	48	$707.92	$241.42
11102 Tangential biopsy of single skin lesion	48	43	$143.46	$83.98
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	40	40	$441.75	$273.35
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	34	28	$256.00	$127.08
11103 Biopsy of related skin growth, each additional growth	30	14	$78.20	$54.32
12052 Repair of wound (2.6 to 5.0 centimeters) of face, ears, eyelids, nose, lips, and/or mouth	29	28	$437.00	$164.18
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	26	26	$155.31	$109.50
14060 Repair of wound of eyelids, nose, ears, or lips by transferring skin, 10.0 sq cm or less	24	23	$1128.04	$760.50
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	19	19	$360.21	$126.89
13152 Complicated repair of wound of eyelids, nose, ears, or lip, 2.6-7.5 cm	18	18	$740.00	$260.01
17110 Destruction of up to 14 skin growths	17	16	$160.00	$106.00
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	16	15	$627.00	$248.00
17313 Removal and microscopic exam of growth of trunk, arms, or legs, 1-5 tissue blocks	13	13	$905.46	$589.19
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	12	11	$64.58	$44.76
12051 Intermediate repair of wound of face, ears, eyelids, nose, lips, or mouth, 2.5 cm or less	12	12	$386.00	$215.18
12042 Intermediate repair of wound of neck, hands, feet, or genitals, 2.6-7.5 cm	12	12	$430.00	$227.13
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	11	11	$412.00	$144.95

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17311 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, 1-5 tissue blocks	39	36	$958.00	$532.66
17312 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, each additional stage, 1-5 tissue blocks	30	21	$579.00	$371.62
99213 Established patient office or other outpatient visit, typically 15 minutes	29	26	$99.00	$72.56
11100 Biopsy of single growth of skin and/or tissue	21	20	$154.00	$90.89
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	15	15	$432.00	$283.98
17000 Destruction of skin growth	12	12	$114.00	$44.26

Medical Specialties & State Licenses

CMS Verified: 2026-07-21

Dermatology - MOHS-Micrographic Surgery Primary Specialty

NUCC Taxonomy Code: 207ND0101X

State License OR MD195653

The highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S.

Dermatology

NUCC Taxonomy Code: 207N00000X

State License SC MMD89666MD

A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.

Dermatology - MOHS-Micrographic Surgery

NUCC Taxonomy Code: 207ND0101X

State License SC MMD89666MD

Dermatology

NUCC Taxonomy Code: 207N00000X

State License NC 2023-00924

Dermatology - MOHS-Micrographic Surgery

NUCC Taxonomy Code: 207ND0101X

State License NC 2023-00924

Hospital & Practice Group Affiliations

Dermatologic Surgery Of The Carolinas Llc

420 Herlong Ave S, Rock Hill, SC 297321091

Phone: 70491911055

Dermatologic Surgery Of The Carolinas Llc

15830 Ballantyne Medical Pl, Charlotte, NC 282770760

Phone: 70491911055

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

1 Associated Practitioners

Dr. Gerald Peters , MD

Dermatology - MOHS-Micrographic Surgery

NPI 1891703021

Doctor of Medicine (M.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

22 Historical Events

📍

Updated Practice Location July 21, 2026

Registered at 2353 NE CONNERS AVE, BEND, OR 977016068 (Tel: 5413237546)

📍

Updated Business Mailing Address July 21, 2026

Registered at 2353 NE CONNERS AVE, BEND, OR 977016068 (Tel: 5413237546)

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) July 21, 2026

Dermatology (License #MMD89666MD in SC)

📍

Updated Practice Location August 29, 2023

Registered at 15830 BALLANTYNE MEDICAL PL STE 225, CHARLOTTE, NC 282770760 (Tel: 7049191105)

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) August 29, 2023

Dermatology (License #2023-00924 in NC)

📍

Updated Practice Location April 16, 2020

Registered at 815 SW BOND ST, BEND, OR 977023593 (Tel: 5413822811)

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) April 16, 2020

Dermatology (License #DR.0060565 in CO)

📍

Updated Practice Location October 31, 2018

Registered at 1390 S POTOMAC ST STE 124, DENVER, CO 800124529 (Tel: 3033688611)

📍

Updated Business Mailing Address October 31, 2018

Registered at 1390 S POTOMAC ST STE 124, AURORA, CO 800124529 (Tel: 3033688611)

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) March 17, 2018

Dermatology (License #35.130337 in OH)

✅

NPI Profile Active June 17, 2017

NPI status registered as active in NPPES database

📍

Updated Business Mailing Address June 17, 2017

Registered at 2832 WEST 12TH STREET, CLEVELAND, OH 44113 (Tel: 3525142060)

📍

Updated Practice Location June 17, 2017

Registered at 1500 E MEDICAL CENTER DR, 1910 A. ALFRED TAUBMAN CENTER, SPC 5314, ANN ARBOR, MI 481095000 (Tel: 7349366674)

👤

Provider Name / Credentials Updated June 17, 2017

Recorded as MATTHEW CLARK, M.D.

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) June 17, 2017

Dermatology (License #4301105112 in MI)

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) May 25, 2017

Dermatology (License #35.130337 in OH)

✅

NPI Profile Active January 05, 2017

NPI status registered as active in NPPES database

📍

Updated Practice Location January 05, 2017

Registered at 1500 E MEDICAL CENTER DR, 1910 A. ALFRED TAUBMAN CENTER, SPC 5314, ANN ARBOR, MI 481095000 (Tel: 7349366674)

📍

Updated Business Mailing Address January 05, 2017

Registered at 1500 E MEDICAL CENTER DR, 1910 A. ALFRED TAUBMAN CENTER, SPC 5314, ANN ARBOR, MI 481095000 (Tel: 7349366674)

👤

Provider Name / Credentials Updated January 05, 2017

Recorded as MATTHEW CLARK, M.D.

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) January 05, 2017

Dermatology (License #4301105112 in MI)

🟢

Initial NPI Registration & Enumeration May 30, 2013

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

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NPI Administrative Meta

NPI Number: 1194162230

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: May 30, 2013

Last Update: July 21, 2026

Sole Proprietor: Yes

Update or Correct Profile

Mailing Address

2353 Ne Conners Ave

Bend, OR 977016068

Phone: 5413237546

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.