Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mr. Jeremy Gaylon Waldie, PA-C

Individual provider Physician Assistant · NPI 1043546534

Mr. Jeremy Gaylon Waldie, PA-C is a Physician Assistant in Salem, Oregon. Qualified in 2009, 17 years ago. Practices with Icco LLC, a 133-clinician group and accepts Medicare assignment. Licensed in Oregon and Washington.

Years since qualifying
17
Licensed in
OR, WA
In the registry since
2009
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

374 Owens St SE
Salem, OR 97302-4183
Phone: (503) 399-1400
Fax: (503) 399-1406
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA165500 (OR)
Medical Physician Assistant Taxonomy 363AM0700X · Licence PA60120298 (WA)

Record details

NPI number1043546534
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedOctober 19, 2009
Last updated in NPPESFebruary 13, 2020
Certification dateFebruary 13, 2020

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2009 (17 years in practice)
Group practice Icco Llc — 133 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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