Ingrid Large Edstrom, BSN CFNP MED

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

200550045NPPP Issued in OR

Practice address

315 Goodpasture Island Rd
Eugene, OR 97401-2109

Phone

(541) 302-2977

Fax

(541) 302-6565

NPI assigned

Apr 21, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Other names 1

• Ingrid Padberg Former name

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Bachelor on Science - Nursing, Master of Education, Nurse Practitioner

State licenses

Practice roles

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.

• Infrared Breast Health,LLC

  • Women's Health Nurse Practitioner
  • Eugene, OR
  • NPI 1689819773
  NPD (past) Authorized official

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

{
    "created_epoch": "1145577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626393600000",
    "number": "1689630410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1102 HODSON LN",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974042944",
            "telephone_number": "541-302-2977",
            "fax_number": "541-302-6565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 GOODPASTURE ISLAND RD",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974012109",
            "telephone_number": "541-302-2977",
            "fax_number": "541-302-6565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDSTROM",
        "first_name": "INGRID",
        "middle_name": "LARGE",
        "name_prefix": "Ms.",
        "credential": "BSN CFNP MED",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-21",
        "last_updated": "2021-07-16",
        "certification_date": "2021-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MA",
            "license": "1113222",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OR",
            "license": "200550045NPPP",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "269858",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OR FNP#",
            "identifier": "200550045NPPP",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "NP2194",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "INGRID",
            "last_name": "PADBERG",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Arthur J Edelmann, PHD
• Lori Ann Edmond, LPN
• Erin Rachelle Edmunds, AGACNP-BC
• John T Ednoff, QMHA, CPRP
• Jean Ann Edsall, MD
• Edward M. Thatcher
• Albert Owen Edwards, MD, PHD
• Corie Rose Edwards, N.D.
• Falyn Edwards
• Gina Copeland Edwards, MA, PHD

• Family Nurse Practitioner in Eugene, OR
• Providers in Eugene, OR by specialty
• Family Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.