NPIMap

Individual provider Active NPI

Josiah Jackson Dick, PA

  • Physician Assistant
  • Springfield, OR
National Provider Identifier
1699366740
Registry record updated Apr 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA209411 Issued in OR
Practice address
1460 G St
Springfield, OR 97477-4112
Phone
(541) 726-3166
NPI assigned
Feb 1, 2021
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 21, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Physician Assistant 363A00000X PA209411 OR Primary

Addresses

Primary practice location

1460 G St
Springfield, OR 97477-4112

Mailing address

PO Box 3028
San Dimas, CA 91773-7028
Phone (541) 726-3166

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
I20220606003008 OR Practitioner - Physician Assistant 8426436254 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Icco LLCGroup PAC ID 1355406729, 133 clinicians

Practice addresses (Care Compare)

186 W Ellendale Ave
Dallas, OR 97338-1408
Phone (541) 640-7625

3400 Cooperative Way
Lebanon, OR 97355-3984
Phone (541) 640-7625

3737 Shasta Way
Suite a
Klamath Falls, OR 97603-4982
Phone (541) 640-7625

598 E 13TH Ave
Eugene, OR 97401-4783
Phone (541) 636-3473

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA209411ORMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Icco LLC CurrentSince Apr 16, 2025 Accepting new patients
Icco, LLC CurrentSince Apr 16, 2025 Accepting new patients
Icco, LLC Past Accepting new patients

Locations

108 NW Sisemore St
Ste 120
Bend, OR 97703
Phone (541) 213-2133

1302 NE 3rd St
Bend, OR 97701
Phone (541) 385-6388

1445 Gateway Blvd
Cottage Grove, OR 97424
Phone (541) 767-3023

186 W Ellendale Ave
Dallas, OR 97338
Phone (971) 900-4984

1800 Coburg Rd
Eugene, OR 97401
Phone (541) 342-1632

4040 W 11th Ave
Ste B
Eugene, OR 97402
Phone (458) 215-2311

2710 Willamette St
Eugene, OR 97405
Phone (541) 735-3161

598 E 13th Ave
Eugene, OR 97401
Phone (541) 636-3473

3675 Pacific Ave
#101
Forest Grove, OR 97116
Phone (971) 762-4611

1890 NW 6th St
Grants Pass, OR 97526
Phone (541) 507-0684

1623 N 1st St
Hermiston, OR 97838
Phone (458) 300-9014

355 W 3rd Ave
Junction City, OR 97448
Phone (541) 998-2468

3737 Shasta Way
Ste A
Klamath Falls, OR 97603
Phone (541) 883-2337

3400 Cooperative Way
Lebanon, OR 97355
Phone (541) 333-6605

1755 SW Baker St
McMinnville, OR 97128
Phone (971) 900-4522

1841 E Barnett Rd
Medford, OR 97504
Phone (541) 216-7291

1226 Virginia Ave
North Bend, OR 97459
Phone (541) 305-4224

3818 SW 21st St
Ste 100
Redmond, OR 97756
Phone (541) 548-2899

1555 S Highway 97
#101
Redmond, OR 97756
Phone (541) 204-4304

1740 NW Goetz St
Roseburg, OR 97471
Phone (541) 672-4789

2920 Commercial St SE
Salem, OR 97302
Phone (541) 641-6053

445 Harlow Rd
Ste 100
Springfield, OR 97477
Phone (541) 228-3865

5781 Main St
Springfield, OR 97478
Phone (541) 284-1694

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1612137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682035200000",
    "number": "1699366740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3028",
            "city": "SAN DIMAS",
            "state": "CA",
            "postal_code": "917737028",
            "telephone_number": "541-726-3166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1460 G ST",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "974774112",
            "telephone_number": "541-726-3166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICK",
        "first_name": "JOSIAH",
        "middle_name": "JACKSON",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-02-01",
        "last_updated": "2023-04-21",
        "certification_date": "2023-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA209411",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, OR

Sources for this page

Verify at the official NPI Registry.