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EDEN FAMILY WELLNESS PROF CORP
NPI 1104761980
Chiropractor - Pediatric Chiropractor in Portland, OR

Active since April 20, 2026
5331 S MACADAM AVE STE 285, PORTLAND, OR 97239(971) 400-8787 Get Directions Write a Review

NPPES record last updated: May 11, 2026. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: May 11, 2026, Apr 20, 2026 (2 updates tracked since 2026).

About Eden Family Wellness Prof Corp NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

EDEN FAMILY WELLNESS PROF CORP (NPI 1104761980) is a healthcare organization registered as a pediatric chiropractor in Portland, Oregon and active in the NPI registry since April 2026. The organization lists Aesha Marie Carrillo, Owner, Chiropractor, as its authorized official.

NPPES Registry Identity

NPI1104761980
Entity TypeOrganization
Primary Taxonomy111NP0017X
Legal Business NameEDEN FAMILY WELLNESS PROF CORP
Location Address5331 S MACADAM AVE STE 285Portland, OR 97239-3849
Mailing Address1312 Se Olvera PlGresham, OR 97080-6187 · (503) 206-4082
Phone(971) 400-8787
Organization SubpartNo
Authorized OfficialAesha Marie CarrilloOwner, Chiropractor · (971) 400-8787
Enumeration DateApril 20, 2026
Last NPPES UpdateMay 11, 20262 updates tracked since enumeration
NPPES CertifiedMay 11, 2026
✔ NPI 1104761980 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyChiropractor · Pediatric ChiropractorChiropractic Providers
Taxonomy Code111NP0017X
Definition
The Pediatric Chiropractor is a chiropractor with specialized, advanced training and certification in the evaluation, care and management of health and wellness conditions of infancy, childhood and adolescence. This specialist provides primary, comprehensive, therapeutic and preventative chiropractic health care for newborns through adolescents.
Also ListedChiropractorTaxonomy 111N00000X
5331 S MACADAM AVE STE 285, Portland, OR 97239
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BridgeSpan Health Company, Regence BlueCross BlueShield of Oregon.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Eden Family Wellness Prof Corp is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Eden Family Wellness Prof Corp, which bills Medicare for the services this clinician delivers.

Clinician (1)

Aesha Marie Carrillo, DC
Chiropractic
NPI 1346957271
5331 S MACADAM AVE STE 285
Portland, OR 97239
(503) 206-4082
✔ Accepts MedicareSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Eden Family Wellness Prof Corp's NPI number?

The NPI number for Eden Family Wellness Prof Corp is 1104761980. It was assigned to this organization in the NPPES registry on April 20, 2026.

Where is Eden Family Wellness Prof Corp located?

Eden Family Wellness Prof Corp is located at 5331 S Macadam Ave Ste 285, Portland, OR 97239. The listed phone number is (971) 400-8787.

What is Eden Family Wellness Prof Corp's specialty?

The primary specialty registered for this NPI is Chiropractor, specializing in Pediatric Chiropractor, with taxonomy code 111NP0017X.

Is Eden Family Wellness Prof Corp enrolled in Medicare?

Yes. Eden Family Wellness Prof Corp is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Eden Family Wellness Prof Corp?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Chiropractic) reassigns their Medicare billing to Eden Family Wellness Prof Corp. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

What insurance does Eden Family Wellness Prof Corp accept?

Health plans from BridgeSpan Health Company and Regence BlueCross BlueShield of Oregon list Eden Family Wellness Prof Corp as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Eden Family Wellness Prof Corp was last updated on May 11, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.