Jeremy Gaylon Waldie, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA165500 Issued in OR

Practice address

374 Owens St SE
Salem, OR 97302-4183

Phone

(503) 399-1400

Fax

(503) 399-1406

NPI assigned

Oct 19, 2009

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Icco LLCGroup PAC ID 1355406729, 133 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Salem Health West Valley Hospital, Dallas, OR, CCN 381308

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Icco, LLC

  dba BestMed

  • Urgent Care Clinic/Center
  • Eugene, OR
  • NPI 1407004757
  Medicare reassignment Care Compare group NPD (past)
• Emurgent Care LLC

  • Urgent Care Clinic/Center
  • Dallas, OR
  • NPI 1265871123
  Medicare reassignment
• Pain Care Specialists of Oregon, LLC

  • Pain Medicine (Anesthesiology) Physician
  • Salem, OR
  • NPI 1942675467
  Medicare reassignment
• Icco, LLC

  dba BestMed

  • Rural Health Clinic/Center
  • Junction City, OR
  • NPI 1649886441
  NPD
• Groundswell Integrative Healthcare Inc.

  • Family Medicine Physician
  • Salem, OR
  • NPI 1457790826
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Salem Health West Valley

  • Critical Access Hospital
  • Dallas, OR
  • NPI 1245237486
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1255910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581552000000",
    "number": "1043546534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "374 OWENS ST SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973024183",
            "telephone_number": "503-399-1400",
            "fax_number": "503-399-1406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "374 OWENS ST SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973024183",
            "telephone_number": "503-399-1400",
            "fax_number": "503-399-1406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALDIE",
        "first_name": "JEREMY",
        "middle_name": "GAYLON",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-10-19",
        "last_updated": "2020-02-13",
        "certification_date": "2020-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA165500",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "PA60120298",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "50071199",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sheryl Lynne Wakeling, MA QMHP LPC
• Ellie Waker, PT
• Wal-Mart Stores, Inc (Vision Center 30-5368)
• Wal-Mart Stores, Inc (Vision Center 30-1784)
• Wal-Mart Stores, Inc (Vision Center 30-1920)
• William Zenas Waldon
• Jessica Waldroff
• Walgreen Co (Walgreens #11632)
• Walgreen Co (Walgreens #09650)
• Walgreen Co (Walgreens #09287)

• Physician Assistant in Salem, OR
• Providers in Salem, OR by specialty
• Physician Assistant in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.