Jeffrey Patrick Fry, PH.D., NCSP

Primary specialty

PsychologistTaxonomy code 103T00000X

License

3208 Issued in OR

Practice address

809 E Jackson St
Medford, OR 97504-6713

Phone

(541) 690-2906

Fax

(458) 226-2667

NPI assigned

Jul 3, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

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: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

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.

• Southern Oregon Wellness Clinic, LLC

  • Primary Care Clinic/Center
  • Medford, OR
  • NPI 1538446315
  Medicare reassignment NPD

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

{
    "created_epoch": "1183420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598918400000",
    "number": "1144428855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "809 E JACKSON ST",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975046713",
            "telephone_number": "541-690-2906",
            "fax_number": "458-226-2667"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "809 E JACKSON ST",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975046713",
            "telephone_number": "541-690-2906",
            "fax_number": "458-226-2667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FRY",
        "first_name": "JEFFREY",
        "middle_name": "PATRICK",
        "name_prefix": "Dr.",
        "credential": "PH.D., NCSP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-07-03",
        "last_updated": "2020-09-01",
        "certification_date": "2020-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "OR",
            "license": "3208",
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "FL",
            "license": "SS 903",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cameron D Frombach
• Heather Ashley Fronek, FNP
• Joshua Fronek, DO
• Debra Rae Frost, FNP-C
• Madeline Frost
• Helena Sofia Fuentes Camacho
• Carla Jenifer Fuerst, L.M.T
• Lani C. Fujitsubo, PH.D.
• Megan Evangeline Fuller, MSN, RN, CCM
• Rhone Leanne Fulton, CRM,PSS

• Psychologist in Medford, OR
• Providers in Medford, OR by specialty
• Psychologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2020; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.