NPIMap

Individual provider Active NPI

Eric S Dildine, PA-C

  • Physician Assistant
  • Bend, OR
National Provider Identifier
1194897264
Registry record updated Apr 4, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA01169 Issued in OR
Practice address
2275 NE Doctors Dr.
Suite 5
Bend, OR 97701
Phone
(541) 706-7715
Fax
(541) 706-7742
NPI assigned
Nov 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2013

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 PA01169 OR Primary

Addresses

Primary practice location

2275 NE Doctors Dr.
Suite 5
Bend, OR 97701

Mailing address

PO Box 5579
Bend, OR 97708-5579
Phone (541) 706-7715

Other identifiers 3

IdentifierTypeStateIssuer
00479095OtherORRAILROAD MEDICARE
11745011OtherORCAQH ID
500608143MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070108000324 OR Practitioner - Physician Assistant 1254331788 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Cascade Internal Medicine Specialists LLCGroup PAC ID 8426058694, 3 clinicians

Practice addresses (Care Compare)

2239 NE Doctors Dr
Suite 200
Bend, OR 97701-7185
Phone (541) 318-0124

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
St. Charles Health System, Inc. CurrentSince Jan 23, 2011 Accepting new patients
St. Charles Health System, Inc. CurrentSince Jan 23, 2011 Accepting new patients
Cascade Internal Medicine PS Past Accepting new patients
St. Charles Health System, Inc. Past Accepting new patients

Locations

29358 Network Pl
Chicago, IL 60673

2275 NE Doctors Dr
Ste 5
Bend, OR 97701
Phone (541) 706-6700

1501 NE Medical Center Dr
Bend, OR 97701
Phone (541) 317-4354

2042 NE Williamson Ct
Ste 100
Bend, OR 97701
Phone (541) 526-6603

211 NW Larch Ave
Redmond, OR 97756
Phone (541) 548-2164

1523 NW Canal Blvd
Redmond, OR 97756
Phone (541) 383-3668

Interoperability endpoints

  • Direct secure messaging: edildine24450@coipa.gardenplot.direct-ci.com

Organizations & group practices 5

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.

Hospital & facility affiliations 8

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": "1163462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1365033600000",
    "number": "1194897264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5579",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977085579",
            "telephone_number": "541-706-7715",
            "fax_number": "541-706-7742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2275 NE DOCTORS DR.",
            "address_2": "SUITE 5",
            "city": "BEND",
            "state": "OR",
            "postal_code": "97701",
            "telephone_number": "541-706-7715",
            "fax_number": "541-706-7742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DILDINE",
        "first_name": "ERIC",
        "middle_name": "S",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-14",
        "last_updated": "2013-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA01169",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "00479095",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH ID",
            "identifier": "11745011",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500608143",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bend, OR

Sources for this page

Verify at the official NPI Registry.