NPIMap

Organization Active NPI

Paradigm Mental Health and Wellness LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Medford, OR
National Provider Identifier
1073147716
Registry record updated May 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
PARADIGM MENTAL HEALTH AND WELLNESS LLC
Practice address
724 S Central Ave Ste 101D
Medford, OR 97501-7808
Phone
(541) 324-7171
NPI assigned
Mar 2, 2020
Last updated
May 5, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 5, 2021

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

Authorized official

Name
Mr. Paul Fickes, PMHNPNPI 1710487897
Title
Owner
Phone
(541) 324-7171

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X NU Primary
Professional Counselor 101YP2500X NU
Clinical Social Worker 1041C0700X NU
Family Medicine Physician 207Q00000X NU
Addiction Medicine (Internal Medicine) Physician 207RA0401X NU

Addresses

Primary practice location

724 S Central Ave Ste 101D
Medford, OR 97501-7808

Mailing address

724 S Central Ave Ste 101D
Medford, OR 97501-7808
Phone (541) 249-7724

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210914003177 OR Part B Supplier - Clinic/Group Practice 2961808076 Receives reassigned benefits from 5 practitioners
Practice locations: Medford, OR

National Provider Directory

National Provider Directory

Locations

724 S Central Ave
Ste 101D
Medford, OR 97501
Phone (541) 249-7724

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1583107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620172800000",
    "number": "1073147716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "724 S CENTRAL AVE STE 101D",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975017808",
            "telephone_number": "541-249-7724",
            "fax_number": "541-325-4055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "724 S CENTRAL AVE STE 101D",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975017808",
            "telephone_number": "541-324-7171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARADIGM MENTAL HEALTH AND WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-02",
        "last_updated": "2021-05-05",
        "certification_date": "2021-05-05",
        "status": "A",
        "authorized_official_last_name": "FICKES",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "541-324-7171",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PMHNP"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RA0401X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Medford, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.