Nicholas J Campo III, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

200950092NP Issued in OR

Practice address

233 SW Wilson Ave Ste 201
Bend, OR 97702-2988

Phone

(541) 382-8862

Fax

(541) 382-8928

NPI assigned

Jul 24, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jul 1, 2023 through Jul 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: ncampo680730@direct.ochin.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Life Works of Central Oregon, LLC

  • Professional Counselor
  • Bend, OR
  • NPI 1225169378
  NPD (past)
• Lutheran Community Services Northwest

  • Community/Behavioral Health Agency
  • McMinnville, OR
  • NPI 1255542106
  NPD (past)
• Kongara & Assoc LLC

  • Psychiatry Physician
  • Baton Rouge, LA
  • NPI 1780646901
  NPD (past)
• Lance E Bullock, MD, a Professional Medical Corporation

  • Psychiatry Physician
  • Gonzales, LA
  • NPI 1265465397
  NPD (past)
• Providence Health & Services - Washington

  • Psychiatry Physician
  • Anchorage, AK
  • NPI 1538254347
  NPD (past)

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

{
    "created_epoch": "1216857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1468540800000",
    "number": "1003071499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "233 SW WILSON AVE STE 201",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977022988",
            "telephone_number": "541-382-8862",
            "fax_number": "541-382-8928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "233 SW WILSON AVE STE 201",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977022988",
            "telephone_number": "541-382-8862",
            "fax_number": "541-382-8928"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAMPO",
        "first_name": "NICHOLAS",
        "middle_name": "J",
        "name_prefix": "Mr.",
        "name_suffix": "III",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-24",
        "last_updated": "2016-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OR",
            "license": "200950092NP",
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "AK",
            "license": "1147",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Keith Campbell, MD, PHD
• Melissa Campbell, R.N., IBCLC
• Stacy Ann Campbell, LPC, RPT
• Stephanie Campbell
• W Lawrence Campbell, MD
• Leonardo A Campos, M.D.
• Kimberly K Canaday, RN, ANP
• Tabitha Marie Canales, RN
• Vincent Paul Cancelliere
• Marcella R Canelo, REGISTERED DIETITIAN

• All providers in Bend, OR
• Psychiatric/Mental Health Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2016; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.