Active NPI
Kevin Michael Fickenscher Sr., M.D.
- Family Medicine Physician
- Bend, OR
National Provider Identifier
1750681391
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- G84904
- Practice address
- 3499 NW Braid Drive
Bend, OR 97701-8682 - Phone
- (415) 307-7358
- Fax
- (415) 223-9383
- NPI assigned
- Oct 29, 2010
- Last updated
- Mar 7, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | G84904 | CA | Primary |
Addresses
Primary practice location
3499 NW Braid Drive
Bend, OR 97701-8682
Mailing address
7710 Woodmont Avenue
Suite 211
Bethesda, MD 20814
Phone (415) 450-1515
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| G84904 | Other | CA | CALIFORNIA STATE MEDICAL BOARD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G84904 | CA | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1288310400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1750681391",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7710 WOODMONT AVENUE",
"address_2": "SUITE 211",
"city": "BETHESDA",
"state": "MD",
"postal_code": "20814",
"telephone_number": "415-450-1515"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3499 NW BRAID DRIVE",
"city": "BEND",
"state": "OR",
"postal_code": "977018682",
"telephone_number": "415-307-7358",
"fax_number": "415-223-9383"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FICKENSCHER",
"first_name": "KEVIN",
"middle_name": "MICHAEL",
"name_suffix": "Sr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-10-29",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CA",
"license": "G84904",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CALIFORNIA STATE MEDICAL BOARD",
"identifier": "G84904",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bend, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.