NPIMap

Organization Active NPI

Icco, LLC

  • Clinic/Center
  • Veneta, OR
National Provider Identifier
1083159503
Registry record updated Jun 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
ICCO, LLC
Practice address
25045 Dunham Avenue
Veneta, OR 97487
Phone
(541) 935-2035
NPI assigned
Dec 20, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2022

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

Authorized official

Name
Jennifer Ocker
Title
Administrator
Phone
(541) 935-2200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

25045 Dunham Avenue
Veneta, OR 97487

Mailing address

PO Box 819
25045 Dunham Avenue
Veneta, OR 97487-0819
Phone (541) 935-2035

Other names 2

  • BestMed Doing business as
  • Prime Care Partners Veneta Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090218000510 OR Part B Supplier - Clinic/Group Practice 1355406729 Receives reassigned benefits from 316 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bend, OR; Woodburn, OR; Veneta, OR; Springfield, OR; Salem, OR; Roseburg, OR; Redmond, OR; North Bend, OR…

Other NPIs on the same Medicare enrollment 12

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

598 E 13th Ave
Eugene, OR 97401
Phone (541) 636-3473

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1482192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655683200000",
    "number": "1083159503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 819",
            "address_2": "25045 DUNHAM AVENUE",
            "city": "VENETA",
            "state": "OR",
            "postal_code": "974870819",
            "telephone_number": "541-935-2035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25045 DUNHAM AVENUE",
            "city": "VENETA",
            "state": "OR",
            "postal_code": "97487",
            "telephone_number": "541-935-2035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ICCO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-20",
        "last_updated": "2022-06-20",
        "certification_date": "2022-06-20",
        "status": "A",
        "authorized_official_last_name": "OCKER",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "541-935-2200"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BestMed",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Prime Care Partners Veneta",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Veneta, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2022; 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.