Active NPI
Nicole Lee McClelland, APRN
- Nurse Practitioner
- Medford, OR
National Provider Identifier
1447401500
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 201050102NP
- Practice address
- 760 Golf View Dr
Suite # 200
Medford, OR 97504-9685 - Phone
- (541) 618-4400
- Fax
- (541) 618-4406
- NPI assigned
- Oct 8, 2008
- Last updated
- Jul 1, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 1824 | NE | |
| Nurse Practitioner | 363L00000X | 201050102NP | OR | Primary |
| Nurse Practitioner | 363L00000X | 110995 | NE |
Addresses
Primary practice location
760 Golf View Dr
Suite # 200
Medford, OR 97504-9685
Mailing address
760 Golf View Dr
Suite # 200
Medford, OR 97504-9685
Phone (541) 618-4400
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 201050102NP | Other | OR | STATE - ANP |
| 500629049 | Medicaid | OR | |
| 110995 | Other | NE | APRN STATE LICENSE |
| 52664 | Other | NE | RN STATE LICENSE |
| 201041420RN | Other | OR | STATE LICENSE - RN |
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2007
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
760 Golf View Dr
Unit 200
Medford, OR 97504-9685
Phone (541) 618-4400
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 110995 | NE | MD | Nurse Practitioner |
| 201050102NP | OR | MD | Nurse Practitioner |
Interoperability endpoints
- nicolemcclelland@rccpc.allscriptsdirect.net
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.
-
- Specialist
- Medford, OR
- NPI 1740344597
Hospital & facility affiliations 7
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Asante Rogue Regional Medical Center
- General Acute Care Hospital
- Medford, OR
- NPI 1770587107
-
- General Acute Care Hospital
- Ashland, OR
- NPI 1730628827
-
- General Acute Care Hospital
- Grants Pass, OR
- NPI 1801891809
-
- General Acute Care Hospital
- Klamath Falls, OR
- NPI 1659340370
-
- General Acute Care Hospital
- Crescent City, CA
- NPI 1457367062
-
dba Sutter Coast Community Clinic
- General Practice Physician
- Crescent City, CA
- NPI 1700960267
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1223424000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1372636800000",
"number": "1447401500",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "760 GOLF VIEW DR",
"address_2": "SUITE # 200",
"city": "MEDFORD",
"state": "OR",
"postal_code": "975049685",
"telephone_number": "541-618-4400",
"fax_number": "541-618-4406"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "760 GOLF VIEW DR",
"address_2": "SUITE # 200",
"city": "MEDFORD",
"state": "OR",
"postal_code": "975049685",
"telephone_number": "541-618-4400",
"fax_number": "541-618-4406"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCLELLAND",
"first_name": "NICOLE",
"middle_name": "LEE",
"credential": "APRN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-10-08",
"last_updated": "2013-07-01",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "NE",
"license": "1824",
"primary": false
},
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "OR",
"license": "201050102NP",
"primary": true
},
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "NE",
"license": "110995",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE - ANP",
"identifier": "201050102NP",
"state": "OR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "500629049",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "APRN STATE LICENSE",
"identifier": "110995",
"state": "NE"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RN STATE LICENSE",
"identifier": "52664",
"state": "NE"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE - RN",
"identifier": "201041420RN",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Medford, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2013; 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.