Kristen Ruckdashel

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

603 Medical Pkwy
Enterprise, OR 97828-5124

Phone

(541) 426-4502

Fax

(541) 426-6403

NPI assigned

Oct 8, 2018

Last updated

Oct 8, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Winding Waters Medical ClinicGroup PAC ID 8224346713, 16 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Winding Waters Medical Clinic

  • Federally Qualified Health Center (FQHC)
  • Enterprise, OR
  • NPI 1922475219
  Medicare reassignment Care Compare group NPD
• Winding Waters Medical Clinic

  • Community/Retail Pharmacy
  • Wallowa, OR
  • NPI 1114631322
  NPD

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

{
    "created_epoch": "1538956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538956800000",
    "number": "1114492931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "603 MEDICAL PKWY",
            "city": "ENTERPRISE",
            "state": "OR",
            "postal_code": "978285124",
            "telephone_number": "541-426-4502",
            "fax_number": "541-426-6403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "603 MEDICAL PKWY",
            "city": "ENTERPRISE",
            "state": "OR",
            "postal_code": "978285124",
            "telephone_number": "541-426-4502",
            "fax_number": "541-426-6403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUCKDASHEL",
        "first_name": "KRISTEN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-08",
        "last_updated": "2018-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tyler Robinson
• Tia Rockwell
• Margaret Rodgers
• Chelsee Jane Rohan, LPSC
• Kenneth D Rose, M.D.
• Jacqueline Marie Russell, PMHNP-BC
• Theresa A Russell, FNP
• Margaret J Rystrom, RN, CNL
• Safeway Inc (Safeway Pharmacy #0371)
• Koreen Marie Sanders, RPH

• Behavior Technician in Enterprise, OR
• Providers in Enterprise, OR by specialty
• Behavior Technician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2018; 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.