Robert Didericksen, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

0995173 Issued in CO

Practice address

1501 Pearl St
Eugene, OR 97401-4010

Phone

(541) 342-8437

NPI assigned

Jul 22, 2015

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Center for Family Development, Inc.Group PAC ID 2466629217, 17 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.qualifacts.org/api/fhir/c-f-d/r4/

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.

• Center for Family Development, Inc.

  • Mental Health Counselor
  • Eugene, OR
  • NPI 1265609184
  Medicare reassignment Care Compare group NPD
• Center for Family Development, Inc.

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Eugene, OR
  • NPI 1538150388
  NPD

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

{
    "created_epoch": "1437523200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635984000000",
    "number": "1407231244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1258 HIGH ST",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974013238",
            "telephone_number": "541-342-8437"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 PEARL ST",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974014010",
            "telephone_number": "541-342-8437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIDERICKSEN",
        "first_name": "ROBERT",
        "credential": "PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-07-22",
        "last_updated": "2021-11-04",
        "certification_date": "2021-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CO",
            "license": "0995173",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Wiley Dickerson III, MD
• Elizabeth Dickey
• Virgil Andrew Dickey Jr., N/A
• Zachary Dickison
• John Dickson
• Michael A Diehl, MD
• Daniel Dietel, M.D.
• Jessica Rose Dietrich
• Jennifer Dietz
• Gabriel Difani

• Psychiatric/Mental Health Nurse Practitioner in Eugene, OR
• Providers in Eugene, OR by specialty
• Psychiatric/Mental Health Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.