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Individual provider Active NPI

Timothy Maccurdy, P.A.

  • Physician Assistant
  • Medford, OR
National Provider Identifier
1306999156
Registry record updated Apr 18, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA163288 Issued in OR
Practice address
3156 State St
Medford, OR 97504-8450
Phone
(541) 773-9772
Fax
(541) 773-1113
NPI assigned
Jan 18, 2007
Last updated
Apr 18, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2018

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA10004497 WA
Physician Assistant 363A00000X PA163288 OR Primary
Dermatology Physician 207N00000X PA163288 OR

Addresses

Primary practice location

3156 State St
Medford, OR 97504-8450

Mailing address

815 N Central Ave
Ste C
Medford, OR 97501-5873
Phone (541) 734-9030

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
I20130711000423 OR Practitioner - Physician Assistant 7618954397 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Valley Immediate Care, LLCGroup PAC ID 7618876723, 36 clinicians

Practice addresses (Care Compare)

1401 Siskiyou Blvd
Suite 1
Ashland, OR 97520-2304
Phone (541) 734-9030

1600 Delta Waters Rd
Suite 107
Medford, OR 97504-9114
Phone (541) 858-2515

Merit-based Incentive Payment System (MIPS)

Final score
0 of 100Reported as individual
Quality
0
Promoting interoperability
0
Improvement activities
0
Cost
0

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
22707CAMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
The Speech Center,Inc. PastSince Aug 24, 2009 Accepting new patients
Valley Immediate Care, LLC Past Accepting new patients
Redding Dermatology Medical Group, Inc. Dermatology PastSince Aug 11, 2024 Accepting new patients
Berkeley Emergency Medical Group, Inc. PastSince Jan 22, 2023 Accepting new patients
Ventana Wellness, PC Past Accepting new patients
Berkeley Emergency Medical Group, Inc. PastSince Jan 22, 2023 Accepting new patients
Valley Immediate Care, LLC Past Accepting new patients
Overlake Medical Clinics LLC Past Accepting new patients

Organizations & group practices 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1524009600000",
    "number": "1306999156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "815 N CENTRAL AVE",
            "address_2": "STE C",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975015873",
            "telephone_number": "541-734-9030",
            "fax_number": "541-734-9885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3156 STATE ST",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975048450",
            "telephone_number": "541-773-9772",
            "fax_number": "541-773-1113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACCURDY",
        "first_name": "TIMOTHY",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-18",
        "last_updated": "2018-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA10004497",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA163288",
            "primary": true
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "OR",
            "license": "PA163288",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Medford, OR

Sources for this page

Verify at the official NPI Registry.