Active NPI
Dan Hicks, LPC
- Professional Counselor
- Bend, OR
National Provider Identifier
1811285679
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- C1059
- Practice address
- 143 SW Shevlin Hixon Dr
Suite 201
Bend, OR 97702-3189 - Phone
- (714) 222-4395
- NPI assigned
- Jul 14, 2011
- 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | C1059 | OR | Primary |
Addresses
Primary practice location
143 SW Shevlin Hixon Dr
Suite 201
Bend, OR 97702-3189
Mailing address
143 SW Shevlin Hixon Dr
Suite 201
Bend, OR 97702-3189
Phone (714) 222-4395
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260109000270 | OR | Practitioner - Mental Health Counselor | 8628554623 | Practice locations: Bend, OR |
Care Compare profile
Medicare Care Compare- Specialty
- Mental Health Counselor
- Education
- Other, 1990
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
143 SW Shevlin Hixon Dr
Suite 201
Bend, OR 97702-3189
Phone (714) 222-4395
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C1059 | OR | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1310601600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1310601600000",
"number": "1811285679",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "143 SW SHEVLIN HIXON DR",
"address_2": "SUITE 201",
"city": "BEND",
"state": "OR",
"postal_code": "977023189",
"telephone_number": "714-222-4395"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "143 SW SHEVLIN HIXON DR",
"address_2": "SUITE 201",
"city": "BEND",
"state": "OR",
"postal_code": "977023189",
"telephone_number": "714-222-4395"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HICKS",
"first_name": "DAN",
"name_prefix": "Mr.",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-07-14",
"last_updated": "2011-07-14",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "OR",
"license": "C1059",
"primary": true
}
],
"identifiers": [],
"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 Jul 14, 2011; 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.