Eden Practitioners LLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

EDEN PRACTITIONERS LLC

Practice address

843 E Main St Ste 204
Medford, OR 97504-7137

Phone

(541) 329-0478

Fax

(541) 314-9556

NPI assigned

Aug 20, 2021

Organization subpart

No

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

Authorized official

Name

Dr. Dane FickesNPI 1225514375

Title

Owner

Phone

(541) 329-0478

Specialties & licenses 6

Addresses

Other names 1

• Eden Practitioners Doing business as

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Practitioners 4

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

• Heather L. Barraclough, FNP-C

  • Family Nurse Practitioner
  • Ashland, OR
  • NPI 1841954641
  Medicare reassignment NPD
• Malia Johnson, DNP, FNP

  • Family Nurse Practitioner
  • Medford, OR
  • NPI 1568715456
  Medicare reassignment NPD
• Darrell Elliott Benko, AGPCNP-BC, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • El Paso, TX
  • NPI 1023538139

  OR

  Medicare reassignment NPD
• Dane M Fickes, PHARMD

  • Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
  • Medford, OR
  • NPI 1225514375
  NPD Authorized official

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

{
    "created_epoch": "1629417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660262400000",
    "number": "1376219147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "843 E MAIN ST STE 204",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975047137",
            "telephone_number": "541-329-0478",
            "fax_number": "541-314-9556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "843 E MAIN ST STE 204",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975047137",
            "telephone_number": "541-329-0478",
            "fax_number": "541-314-9556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDEN PRACTITIONERS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-20",
        "last_updated": "2022-08-12",
        "certification_date": "2022-08-12",
        "status": "A",
        "authorized_official_last_name": "FICKES",
        "authorized_official_first_name": "DANE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "541-329-0478",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pharmacist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1835P0018X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LC1500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Community Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eden Practitioners",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Eden Practitioners",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lizabeth M. Eckerd, PH.D.
• Robert Walter Eckert, MD
• Eclectic Behavioral Health Solutions LLC
• Jessica Eddington
• Eden Healthcare LLC
• Brandon Edgar
• Brianna Edmond
• Emmanuel Edson, MD
• Edward a. Helman
• Jake Morgan Edwards, DPT

• 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 Aug 12, 2022; 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.