Jeremy Molck

Primary specialty

CounselorTaxonomy code 101Y00000X

License

PROFESSIONALLICENSE

Practice address

503 Airport Rd Ste 101
Medford, OR 97504-4159

Phone

(541) 200-2900

Fax

(541) 200-2948

NPI assigned

Oct 3, 2022

Last updated

Oct 10, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2018

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Columbiacare Services Inc

  • Psychiatric Residential Treatment Facility
  • Medford, OR
  • NPI 1649466475
  Medicare reassignment NPD
• Columbiacare Services

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Portland, OR
  • NPI 1982140588
  NPD
• Columbiacare Services Inc

  dba Central Clinic

  • Adult Mental Health Clinic/Center
  • Medford, OR
  • NPI 1992223630
  NPD

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

{
    "created_epoch": "1664755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696896000000",
    "number": "1700500790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3587 HEATHROW WAY",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975044004",
            "telephone_number": "541-858-8170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "503 AIRPORT RD STE 101",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975044159",
            "telephone_number": "541-200-2900",
            "fax_number": "541-200-2948"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOLCK",
        "first_name": "JEREMY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-10-03",
        "last_updated": "2023-10-10",
        "certification_date": "2022-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": "PROFESSIONALLICENSE",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Diya F Mohammad, MD
• Tiffany Mohar, QMHP
• Vanessa Noreen Mohrbacher, FNP
• Diana Moissant
• Azusa Mokuta
• Kendra Mollette, CBS
• George W Molzen, MD
• Carolina Mona Keene, DNP-AGACNP-BC
• Chedric Robert Monahan, LCSW
• Jose M Mondesi-Garrido, MD

• Counselor in Medford, OR
• Providers in Medford, OR by specialty
• Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2023; 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.

Verify at the official NPI Registry.