Active NPI
John Pank, LCSW
- Clinical Social Worker
- Portland, OR
National Provider Identifier
1013179316
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 775
- Practice address
- 205 NE 50TH Ave
Portland, OR 97213-2909 - Phone
- (503) 215-2678
- Fax
- (503) 215-2688
- NPI assigned
- Jun 27, 2008
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 775 | OR | Primary |
Addresses
Primary practice location
205 NE 50TH Ave
Portland, OR 97213-2909
Mailing address
PO Box 3395
Portland, OR 97208-3395
Phone (503) 215-4300
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 775 | OR | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1214524800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1214524800000",
"number": "1013179316",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3395",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972083395",
"telephone_number": "503-215-4300",
"fax_number": "503-215-0340"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "205 NE 50TH AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972132909",
"telephone_number": "503-215-2678",
"fax_number": "503-215-2688"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PANK",
"first_name": "JOHN",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-06-27",
"last_updated": "2008-06-27",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "OR",
"license": "775",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.