Individual provider Active NPI

Elmer Paredes, RPA-C

  • Physician Assistant
  • Junction City, OR
National Provider Identifier
1144393133
Registry record updated Dec 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA171617 Issued in OR
Practice address
355 W 3Rd Ave
Junction City, OR 97448-1313
Phone
(541) 640-7625
Fax
(541) 644-3477
NPI assigned
Nov 16, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA171617 OR Primary

Addresses

Primary practice location

355 W 3Rd Ave
Junction City, OR 97448-1313

Mailing address

7730 171St St
Flushing, NY 11366-1407
Phone (718) 969-1949

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
I20151013002094 OR Practitioner - Physician Assistant 2163663055 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Icco LLCGroup PAC ID 1355406729, 133 clinicians

Practice addresses (Care Compare)

1445 Gateway Blvd
Cottage Grove, OR 97424-1224
Phone (541) 942-7000

355 W 3Rd Ave
Junction City, OR 97448-1313
Phone (541) 998-6750

598 E 13TH Ave
Eugene, OR 97401-4783
Phone (541) 636-3473

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA171617ORMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Icco, LLC CurrentSince Jun 28, 2021 Accepting new patients
Peacehealth CurrentSince Feb 27, 2016 Accepting new patients
Icco, LLC Past Accepting new patients

Locations

400 9th St
Florence, OR 97439
Phone (541) 997-8412

355 W 3rd Ave
Junction City, OR 97448
Phone (541) 998-2468

Organizations & group practices 4

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.

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1163635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734480000000",
    "number": "1144393133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7730 171ST ST",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113661407",
            "telephone_number": "718-969-1949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "355 W 3RD AVE",
            "city": "JUNCTION CITY",
            "state": "OR",
            "postal_code": "974481313",
            "telephone_number": "541-640-7625",
            "fax_number": "541-644-3477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAREDES",
        "first_name": "ELMER",
        "name_prefix": "Mr.",
        "credential": "RPA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-16",
        "last_updated": "2024-12-18",
        "certification_date": "2024-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA171617",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Junction City, OR

Sources for this page

Verify at the official NPI Registry.