NPIMap

Individual provider Active NPI

Elisa Fumi Akagi Fukushima, M.D.

  • Internal Medicine Physician
  • Medford, OR
National Provider Identifier
1730568080
Registry record updated Dec 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD204223 Issued in OR
Practice address
1698 E McAndrews Rd Ste 160
Medford, OR 97504
Phone
(541) 732-6070
NPI assigned
May 20, 2015
Last updated
Dec 6, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD204223 OR Primary

Addresses

Primary practice location

1698 E McAndrews Rd Ste 160
Medford, OR 97504

Mailing address

1698 E McAndrews Rd Ste 160
Medford, OR 97504-5590
Phone (541) 732-6070

Other identifiers 1

IdentifierTypeStateIssuer
500797738MedicaidOR

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address eakagifukushima2023541@oc.providencedirect.org

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
I20210924001735 OR Practitioner - Infectious DiseasePractitioner - Internal Medicine 9537462460 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Infectious DiseaseAlso: Internal Medicine
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1111 Crater Lake Ave
Medford, OR 97504-6241
Phone (541) 732-5545

1698 E McAndrews Rd
Medford, OR 97504-5590

940 Royal Ave
Medford, OR 97504-6194

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services - Oregon Current Accepting new patients
Providence Health & Services - Oregon Internal Medicine CurrentSince Oct 1, 2021 Accepting new patients
Providence Health & Services Oregon Internal Medicine Current Accepting new patients
Providence Health & Services - Oregon CurrentSince Oct 1, 2021 Accepting new patients
Providence Health & Services - Oregon CurrentSince Oct 1, 2021 Accepting new patients

Locations

1111 Crater Lake Ave
Medford, OR 97504
Phone (541) 732-5250

1698 E McAndrews Rd
Medford, OR 97504
Phone (503) 215-4300

1698 E McAndrews Rd
Ste 160
Medford, OR 97504
Phone (541) 732-6070

940 Royal Ave
Unit 350
Medford, OR 97504
Phone (541) 732-7460

Interoperability endpoints

  • Direct secure messaging: eakagifukushima2023541@oc.providencedirect.org
  • Direct secure messaging: eakagifukushima742481@direct.hfhs.org

Organizations & group practices 5

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 6

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": "1432080000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638748800000",
    "number": "1730568080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1698 E MCANDREWS RD STE 160",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975045590",
            "telephone_number": "541-732-6070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1698 E MCANDREWS RD STE 160",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "97504",
            "telephone_number": "541-732-6070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AKAGI FUKUSHIMA",
        "first_name": "ELISA",
        "middle_name": "FUMI",
        "name_prefix": "Ms.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-05-20",
        "last_updated": "2021-12-06",
        "certification_date": "2021-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "MD204223",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500797738",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "eakagifukushima2023541@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "1698 E McAndrews Rd",
            "city": "Medford",
            "state": "OR",
            "country_code": "US",
            "postal_code": "975045589",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Medford, OR

Sources for this page

Verify at the official NPI Registry.