Individual provider Active NPI

Jakob Forrest Freid, M.D.

  • Emergency Medicine Physician
  • Klamath Falls, OR
National Provider Identifier
1477750347
Registry record updated Aug 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
MD28480 Issued in OR
Practice address
2865 Daggett Ave
Klamath Falls, OR 97601-1106
Phone
(541) 274-6177
NPI assigned
Jul 2, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 30, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X MD28480 OR Primary

Addresses

Primary practice location

2865 Daggett Ave
Klamath Falls, OR 97601-1106

Mailing address

3830 Beverly Dr
Klamath Falls, OR 97603-3714
Phone (503) 523-7708

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090915000837 OR Practitioner - Emergency Medicine 4082760152 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Creighton University School of Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sky Lakes Medical Center IncGroup PAC ID 1052204096, 196 clinicians

Practice addresses (Care Compare)

2865 Daggett Ave
Klamath Falls, OR 97601-1106
Phone (541) 274-6221

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD28480ORMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sky Lakes Medical Center Inc CurrentSince Jul 30, 2009 Accepting new patients
Sky Lakes Medical Center Inc CurrentSince Jul 30, 2009 Accepting new patients
Southern Oregon Emergency Care LLC Emergency Medicine Past Accepting new patients
West Physician Services LLC Past Accepting new patients

Locations

2865 Daggett Ave
Klamath Falls, OR 97601
Phone (541) 833-6221

Organizations & group practices 4

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.

Hospital & facility affiliations 2

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": "1183334400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1346284800000",
    "number": "1477750347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3830 BEVERLY DR",
            "city": "KLAMATH FALLS",
            "state": "OR",
            "postal_code": "976033714",
            "telephone_number": "503-523-7708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2865 DAGGETT AVE",
            "city": "KLAMATH FALLS",
            "state": "OR",
            "postal_code": "976011106",
            "telephone_number": "541-274-6177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREID",
        "first_name": "JAKOB",
        "middle_name": "FORREST",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-07-02",
        "last_updated": "2012-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OR",
            "license": "MD28480",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Klamath Falls, OR

Sources for this page

Verify at the official NPI Registry.