Individual provider Active NPI

Sophia Kennen Giacomelli

  • Nurse Practitioner
  • Medford, OR
National Provider Identifier
1124736764
Registry record updated Oct 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
10048417 Issued in OR
Practice address
3617 S Pacific Hwy
Medford, OR 97501-8957
Phone
(541) 535-6239
NPI assigned
Nov 14, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 10048417 OR Primary

Addresses

Primary practice location

3617 S Pacific Hwy
Medford, OR 97501-8957

Mailing address

931 Chevy Way
Medford, OR 97504-4127

Other practice location 1

638 Market St
Medford, OR 97504-6126
Phone (541) 535-6239

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20250925001558 OR Practitioner - Nurse Practitioner 4486159951 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Oregon Health Sciences University School of Medicine, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3617 S Pacific Hwy
Medford, OR 97501-8957
Phone (541) 535-6239

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
La Clinica del Valle Family Health Care Center Inc. CurrentSince Oct 1, 2025 Accepting new patients
La Clinica del Valle Family Health Care Center Inc. CurrentSince Oct 1, 2025 Accepting new patients

Locations

931 Chevy Way
Medford, OR 97504
Phone (541) 690-3555

910 S Central Ave
Medford, OR 97501
Phone (541) 618-1380

3617 S Pacific Hwy
Medford, OR 97501
Phone (541) 512-3182

4940 Hamrick Rd
Medford, OR 97502
Phone (541) 512-3900

638 Market St
Medford, OR 97504
Phone (541) 494-3840

730 Biddle Rd
Medford, OR 97504
Phone (541) 210-5674

1307 W Main St
Medford, OR 97501
Phone (541) 618-1314

221 W Stewart Ave
Ste 101
Medford, OR 97501
Phone (541) 690-3500

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1668384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759795200000",
    "number": "1124736764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "931 CHEVY WAY",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975044127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3617 S PACIFIC HWY",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975018957",
            "telephone_number": "541-535-6239"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "638 Market St",
            "address_purpose": "LOCATION",
            "city": "Medford",
            "state": "OR",
            "postal_code": "975046126",
            "country_code": "US",
            "telephone_number": "541-535-6239",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GIACOMELLI",
        "first_name": "SOPHIA",
        "middle_name": "KENNEN",
        "name_prefix": "Ms.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-11-14",
        "last_updated": "2025-10-07",
        "certification_date": "2025-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OR",
            "license": "10048417",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Medford, OR

Sources for this page

Verify at the official NPI Registry.