NPIMap

Individual provider Active NPI

Edward Clark Cullen, MD

  • Internal Medicine Physician
  • Medford, OR
National Provider Identifier
1447257308
Registry record updated Sep 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD16629 Issued in OR
Practice address
1910 E. Barnett Rd
Suite 102
Medford, OR 97504-8672
Phone
(541) 727-8972
Fax
(833) 638-0201
NPI assigned
Jul 6, 2005
Last updated
Sep 15, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD16629 OR Primary

Addresses

Primary practice location

1910 E. Barnett Rd
Suite 102
Medford, OR 97504-8672

Mailing address

1910 E. Barnett Rd
Suite 102
Medford, OR 97504-8672
Phone (541) 727-8972

Other names 1

  • Dr. E. Clark Cullen Professional name

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
I20101201000850 OR Practitioner - Internal Medicine 1052507142 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of California, San Diego School of Medicine, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Sunstone Primary Care PCGroup PAC ID 6901213073, 4 clinicians

Practice addresses (Care Compare)

1910 E Barnett Rd
Suite 102
Medford, OR 97504-8672
Phone (541) 727-8972

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Interoperability endpoints

  • Direct secure messaging: ecullen306845@oc.providencedirect.org
  • Direct secure messaging: edward.cullen.1@23449.direct.athenahealth.com

Organizations & group practices 1

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1120608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631664000000",
    "number": "1447257308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1910 E. BARNETT RD",
            "address_2": "SUITE 102",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975048672",
            "telephone_number": "541-727-8972",
            "fax_number": "833-638-0201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1910 E. BARNETT RD",
            "address_2": "SUITE 102",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975048672",
            "telephone_number": "541-727-8972",
            "fax_number": "833-638-0201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CULLEN",
        "first_name": "EDWARD",
        "middle_name": "CLARK",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-06",
        "last_updated": "2021-09-15",
        "certification_date": "2021-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "MD16629",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "E.",
            "last_name": "CULLEN",
            "middle_name": "CLARK",
            "prefix": "DR.",
            "credential": "MD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Medford, OR

Sources for this page

Verify at the official NPI Registry.