Active NPI
Icco, LLC
Doing business as Musculoskeletal Clinic
- Sports Medicine (Family Medicine) Physician
- Eugene, OR
National Provider Identifier
1437660768
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Medicine (Family Medicine) Physician
- Legal business name
- ICCO, LLC
- Doing business as
- Musculoskeletal Clinic
- Practice address
- 598 E 13TH Ave
Eugene, OR 97401-4783 - Phone
- (541) 844-0233
- Fax
- (541) 505-7486
- NPI assigned
- Oct 13, 2017
- Last updated
- Jul 16, 2019
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Lora Peterson
- Title
- Clinic Manager
- Phone
- (541) 541-8440
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Medicine (Family Medicine) Physician | 207QS0010X | NU | Primary |
Addresses
Primary practice location
598 E 13TH Ave
Eugene, OR 97401-4783
Mailing address
1292 High St Ste 224
Eugene, OR 97401-3238
Phone (541) 228-3865
Other names 1
- Musculoskeletal Clinic
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090218000510 | OR | Part B Supplier - Clinic/Group Practice | 1355406729 |
Receives reassigned benefits from 316 practitioners 12 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Bend, OR; Woodburn, OR; Veneta, OR; Springfield, OR; Salem, OR; Roseburg, OR; Redmond, OR; North Bend, OR… |
Other NPIs on the same Medicare enrollment 12
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
dba Harrisburg Medical Clinic
- Primary Care Clinic/Center
- Harrisburg, OR
- NPI 1922458371
O20090218000510
-
dba Veneta Medical Clinic
- Family Medicine Physician
- Veneta, OR
- NPI 1518990621
O20090218000510
-
dba Thurston Urgent Care
- Urgent Care Clinic/Center
- Springfield, OR
- NPI 1528356953
O20090218000510
-
dba Atlas Physical and Hand Therapy
- Physical Therapist
- Eugene, OR
- NPI 1528385754
O20090218000510
-
dba Eugene Urgent Care-Coburg
- Urgent Care Clinic/Center
- Eugene, OR
- NPI 1902131022
O20090218000510
National Provider Directory
National Provider Directory- Tax ID family
- Icco LLC
Other organizations with this tax ID 14
Organizations that report the same tax identification number in the National Provider Directory.
-
- Primary Care Clinic/Center
- Eugene, OR
- NPI 1821549536
-
dba Pleasant Hill Medical Clinic
- Primary Care Clinic/Center
- Pleasant Hill, OR
- NPI 1922541184
Locations
1555 S Highway 97
#101
Redmond, OR 97756
Phone (541) 204-4304
Practitioners & affiliated clinicians
Practitioners 20
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Psychiatric/Mental Health Nurse Practitioner
- Portland, OR
- NPI 1093260622
-
- Medical Physician Assistant
- Junction City, OR
- NPI 1124460217
-
- Primary Care Nurse Practitioner
- Springfield, OR
- NPI 1841935848
-
- Family Nurse Practitioner
- Springfield, OR
- NPI 1881145191
-
- Nurse Practitioner
- Bend, OR
- NPI 1730547688
-
- Surgical Physician Assistant
- Corvallis, OR
- NPI 1154763050
-
- Medical Physician Assistant
- The Dalles, OR
- NPI 1720405145
-
- Occupational Medicine Physician
- Albany, OR
- NPI 1417177304
-
- Gerontology Nurse Practitioner
- Eugene, OR
- NPI 1326730615
-
- Occupational Medicine Physician
- Bend, OR
- NPI 1699499582
-
- Physician Assistant
- Springfield, OR
- NPI 1720329873
-
- Medical Physician Assistant
- Oakridge, OR
- NPI 1679636484
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1507852800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1563235200000",
"number": "1437660768",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1292 HIGH ST STE 224",
"city": "EUGENE",
"state": "OR",
"postal_code": "974013238",
"telephone_number": "541-228-3865",
"fax_number": "541-654-4693"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "598 E 13TH AVE",
"city": "EUGENE",
"state": "OR",
"postal_code": "974014783",
"telephone_number": "541-844-0233",
"fax_number": "541-505-7486"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ICCO, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2017-10-13",
"last_updated": "2019-07-16",
"status": "A",
"authorized_official_last_name": "PETERSON",
"authorized_official_first_name": "LORA",
"authorized_official_title_or_position": "CLINIC MANAGER",
"authorized_official_telephone_number": "541-541-8440"
},
"taxonomies": [
{
"code": "207QS0010X",
"taxonomy_group": "",
"desc": "Family Medicine, Sports Medicine",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Musculoskeletal Clinic",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Eugene, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2019; 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.