Active NPI
Shelly Myume Emi Fickes, LCSW
- Clinical Social Worker
- Medford, OR
National Provider Identifier
1194315069
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- L10457
- Practice address
- 724 S Central Ave
Medford, OR 97501-7851 - Phone
- (541) 249-7724
- Fax
- (541) 325-4055
- NPI assigned
- Jan 24, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | L10457 | OR | Primary |
Addresses
Primary practice location
724 S Central Ave
Medford, OR 97501-7851
Mailing address
724 S Central Ave
Medford, OR 97501-7851
Phone (541) 249-7724
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Jan 18, 2026 through Jan 18, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L10457 | OR | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Paradigm Mental Health and Wellness LLC | Clinical | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Psychiatric/Mental Health Nurse Practitioner
- Medford, OR
- NPI 1073147716
Clinical
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1611446400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1611446400000",
"number": "1194315069",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "724 S CENTRAL AVE",
"city": "MEDFORD",
"state": "OR",
"postal_code": "975017851",
"telephone_number": "541-249-7724",
"fax_number": "541-325-4055"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "724 S CENTRAL AVE",
"city": "MEDFORD",
"state": "OR",
"postal_code": "975017851",
"telephone_number": "541-249-7724",
"fax_number": "541-325-4055"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FICKES",
"first_name": "SHELLY MYUME",
"middle_name": "EMI",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-01-24",
"last_updated": "2021-01-24",
"certification_date": "2021-01-24",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "OR",
"license": "L10457",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Medford, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2021; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.