NPIMap

Organization Active NPI

Icco LLC

Doing business as Harrisburg Medical Clinic

  • Primary Care Clinic/Center
  • Harrisburg, OR
National Provider Identifier
1922458371
Registry record updated Jun 13, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
ICCO LLC
Doing business as
Harrisburg Medical Clinic
Nova Health Harrisburg
Practice address
420 Smith St
Harrisburg, OR 97446
Phone
(541) 995-5266
Fax
(541) 995-5245
NPI assigned
Jun 16, 2016
Last updated
Jun 13, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2019

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

Authorized official

Name
Dr. Douglas D Bailey, M.D.
Title
Medical Director Harrisburg Clinic
Phone
(541) 998-6750

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X OR Primary
Urgent Care Clinic/Center 261QU0200X OR

Addresses

Primary practice location

420 Smith St
Harrisburg, OR 97446

Mailing address

1292 High St
Suite 224
Eugene, OR 97401-3238
Phone (541) 641-6053

Other names 2

  • Harrisburg Medical Clinic Doing business as
  • Nova Health Harrisburg Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090218000510 OR Part B Supplier - Clinic/Group Practice 1355406729 Receives reassigned benefits from 316 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bend, OR; Woodburn, OR; Veneta, OR; Springfield, OR; Salem, OR; Roseburg, OR; Redmond, OR; North Bend, OR…

Other NPIs on the same Medicare enrollment 12

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1466035200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560384000000",
    "number": "1922458371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1292 HIGH ST",
            "address_2": "SUITE 224",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974013238",
            "telephone_number": "541-641-6053",
            "fax_number": "541-485-9987"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 SMITH ST",
            "city": "HARRISBURG",
            "state": "OR",
            "postal_code": "97446",
            "telephone_number": "541-995-5266",
            "fax_number": "541-995-5245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ICCO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-16",
        "last_updated": "2019-06-13",
        "status": "A",
        "authorized_official_last_name": "BAILEY",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR HARRISBURG CLINIC",
        "authorized_official_telephone_number": "541-998-6750",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "OR",
            "license": null,
            "primary": true
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "OR",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Harrisburg Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Nova Health Harrisburg",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Harrisburg, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.