Rogue Valley Pain Physical & Regenerative Medicine LLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

ROGUE VALLEY PAIN PHYSICAL & REGENERATIVE MEDICINE LLC

Practice address

845 Alder Creek Dr
Medford, OR 97504-8900

Phone

(541) 200-0924

Fax

(541) 200-0929

NPI assigned

May 31, 2023

Organization subpart

No

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

Authorized official

Name

Eric WruckNPI 1528195310

Title

Owner

Phone

(808) 250-1166

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Eric Wruck, DC, FNP-C

  • Nurse Practitioner
  • Kahului, HI
  • NPI 1528195310

  OR

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1685491200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1685491200000",
    "number": "1285327635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4951 GRIFFIN CREEK RD",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975019586",
            "telephone_number": "541-200-0924",
            "fax_number": "541-200-0929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "845 ALDER CREEK DR",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975048900",
            "telephone_number": "541-200-0924",
            "fax_number": "541-200-0929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROGUE VALLEY PAIN PHYSICAL & REGENERATIVE MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-31",
        "last_updated": "2023-05-31",
        "certification_date": "2023-05-31",
        "status": "A",
        "authorized_official_last_name": "WRUCK",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "808-250-1166"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rogue Valley Manor
• Rogue Valley Manor, Inc
• Rogue Valley of Cascadia, LLC
• Rogue Valley Optometric Clinic PC
• Rogue Valley Oral & Maxillofacial Surgery, PC
• Rogue Valley Physicians
• Rogue Valley Physicians
• Rogue Valley Physicians
• Rogue Valley Physicians
• Rogue Valley Physicians

• Family Nurse Practitioner in Medford, OR
• Providers in Medford, OR by specialty
• Family Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.