NPIMap

Individual provider Active NPI

Joseph Nathaniel Pack, MD

  • Emergency Medicine Physician
  • Klamath Falls, OR
National Provider Identifier
1578765012
Registry record updated Apr 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
MD29036 Issued in OR
Practice address
2865 Daggett Ave
Klamath Falls, OR 97601-1106
Phone
(541) 274-6177
NPI assigned
Jun 5, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 4301087613 MI
Emergency Medicine Physician 207P00000X MD29036 OR Primary

Addresses

Primary practice location

2865 Daggett Ave
Klamath Falls, OR 97601-1106

Mailing address

2865 Daggett Ave
Klamath Falls, OR 97601-1106
Phone (541) 274-6177

Other practice location 1

520 Rose Ln
Wickenburg, AZ 85390-1447
Phone (928) 668-1803

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, AZ, TX3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20090915000786 OR Practitioner - Emergency Medicine 4688730062 Reassigns benefits to 1 organization
I20150610001765 AZ Practitioner - Emergency Medicine 4688730062 Reassigns benefits to 4 organizations
I20201223000876 TX Practitioner - Emergency Medicine 4688730062 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of Arizona College of Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Innova Emergency Medical Associates PCGroup PAC ID 2860633435, 69 clinicians

Practice addresses (Care Compare)

1501 N Williamson Ave
Winslow, AZ 86047-2735
Phone (844) 466-6827

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Winslow Indian Health Care Group CurrentSince Aug 22, 2024 Accepting new patients
Sky Lakes Medical Center Inc CurrentSince Sep 2, 2009 Accepting new patients
Summit Healthcare Association CurrentSince Jul 11, 2016 Accepting new patients
Summit Healthcare Medical Associates CurrentSince Nov 1, 2017 Accepting new patients
Innova Emergency Medical Associates PC Emergency Medicine CurrentSince Jul 31, 2017 Accepting new patients
Winslow Indian Health Care Center, Inc CurrentSince Aug 22, 2024 Accepting new patients
Summit Healthcare Medical Associates CurrentSince Nov 1, 2017 Accepting new patients
Winslow Indian Health Care Center, Inc Current Accepting new patients
Community Hospital Association, Inc. Current Accepting new patients
Dilkon Medical Center Current Accepting new patients
Sky Lakes Medical Center Inc CurrentSince Sep 2, 2009 Accepting new patients
Emcare Physician Providers, Inc Emergency Medicine Past Accepting new patients
Southern Oregon Emergency Care LLC Emergency Medicine Past Accepting new patients
West Physician Services LLC Past Accepting new patients

Locations

3269 N Stockton Hill Rd
Kingman, AZ 86409
Phone (928) 757-0626

2200 E Show Low Lake Rd
Show Low, AZ 85901
Phone (928) 537-4375

520 Rose Ln
Wickenburg, AZ 85390
Phone (928) 666-1197

500 Indiana Ave
Winslow, AZ 86047

1501 N Williamson Ave
Winslow, AZ 86047
Phone (928) 289-4691

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

Interoperability endpoints

  • Direct secure messaging: josephpack@shrmcshma.allscriptsdirect.net

Organizations & group practices 14

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.

View all 14

Hospital & facility affiliations 4

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": "1181001600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714089600000",
    "number": "1578765012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2865 DAGGETT AVE",
            "city": "KLAMATH FALLS",
            "state": "OR",
            "postal_code": "976011106",
            "telephone_number": "541-274-6177"
        },
        {
            "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": [
        {
            "address_1": "520 Rose Ln",
            "address_purpose": "LOCATION",
            "city": "Wickenburg",
            "state": "AZ",
            "postal_code": "853901447",
            "country_code": "US",
            "telephone_number": "928-668-1803",
            "fax_number": "928-684-2434",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PACK",
        "first_name": "JOSEPH",
        "middle_name": "NATHANIEL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-05",
        "last_updated": "2024-04-26",
        "certification_date": "2024-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MI",
            "license": "4301087613",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OR",
            "license": "MD29036",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Klamath Falls, OR

Sources for this page

Verify at the official NPI Registry.