Healthcare Provider Details

I. General information

NPI: 1700142122
Provider Name (Legal Business Name): MATTHEW JAN INGRASSIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2012
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NE NEFF RD
BEND OR
97701-6015
US

IV. Provider business mailing address

2275 NE DOCTORS DR STE 7
BEND OR
97701-6324
US

V. Phone/Fax

Practice location:
  • Phone: 541-706-6892
  • Fax: 541-706-6813
Mailing address:
  • Phone: 541-728-2114
  • Fax: 541-749-2126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2020-03773
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2020-03773
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDO169804
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: