Edward A Ricketts, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

MD18739 Issued in OR

Practice address

600 NW 11TH St
Suite109
Hermiston, OR 97838-8602

Phone

(541) 567-5075

NPI assigned

Feb 12, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1190937600000",
    "number": "1215079710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 NW 11TH ST",
            "address_2": "SUITE109",
            "city": "HERMISTON",
            "state": "OR",
            "postal_code": "978388602",
            "telephone_number": "541-567-5075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 NW 11TH ST",
            "address_2": "SUITE109",
            "city": "HERMISTON",
            "state": "OR",
            "postal_code": "978388602",
            "telephone_number": "541-567-5075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RICKETTS",
        "first_name": "EDWARD",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-12",
        "last_updated": "2007-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "MD18739",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060595",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Rhonda Jean Riley, MA
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• Robert D Rolen III OD LLC
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• Internal Medicine Physician in Hermiston, OR
• Providers in Hermiston, OR by specialty
• Internal Medicine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.