Individual provider Active NPI

Nicodemus Reid Solorio, PA-C

  • Physician Assistant
  • Medford, OR
National Provider Identifier
1386420776
Registry record updated Sep 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1600 Delta Waters Rd
Medford, OR 97504-9114
Phone
(541) 858-2515
Fax
(541) 858-2514
NPI assigned
Sep 1, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2023

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 Primary

Addresses

Primary practice location

1600 Delta Waters Rd
Medford, OR 97504-9114

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: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231009002813 OR Practitioner - Physician Assistant 7315392578 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
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)

10586 Hwy 62
Suite a
Eagle Point, OR 97524-9438
Phone (541) 734-9030

1217 Plaza Blvd
Suite a
Central Point, OR 97502-2682
Phone (541) 734-9030

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

162 NE Beacon Dr
Suite 103
Grants Pass, OR 97526-4260
Phone (541) 734-9030

1700 E Barnett Rd
Medford, OR 97504-0052
Phone (541) 734-9030

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Valley Immediate Care, LLC Past Accepting new patients
Valley Immediate Care, LLC Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1693526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693526400000",
    "number": "1386420776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "815 N CENTRAL AVE STE C",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975015873",
            "telephone_number": "541-734-9030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 DELTA WATERS RD",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975049114",
            "telephone_number": "541-858-2515",
            "fax_number": "541-858-2514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOLORIO",
        "first_name": "NICODEMUS",
        "middle_name": "REID",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-09-01",
        "last_updated": "2023-09-01",
        "certification_date": "2023-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Medford, OR

Sources for this page

Verify at the official NPI Registry.