Individual provider Active NPI

Ryely Wilpone, MSW, LCSW

  • Clinical Social Worker
  • Gresham, OR
National Provider Identifier
1033630363
Registry record updated Nov 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
L7672 Issued in OR
Practice address
600 NE 8TH St
Gresham, OR 97030-7317
Phone
(503) 988-5155
Fax
(503) 988-5185
NPI assigned
Jun 27, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X L7672 OR Primary

Addresses

Primary practice location

600 NE 8TH St
Gresham, OR 97030-7317

Mailing address

619 SW 6TH Ave.
5TH FL
Portland, OR 97209-8459
Phone (503) 988-7468

Other identifiers 1

IdentifierTypeStateIssuer
022959MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190802002756 OR Practitioner - Clinical Social Worker 1759618481 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
L7672ORMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Multnomah County CurrentSince Jan 11, 2022 Accepting new patients
Multnomah County CurrentSince Jan 11, 2022 Accepting new patients
Multnomah County Current Accepting new patients

Locations

600 NE 8th St
Gresham, OR 97030
Phone (503) 988-4900

209 SW 4th Ave
Ste 210
Portland, OR 97204
Phone (503) 988-3674

619 NW 6th Ave
Portland, OR 97209
Phone (503) 988-3674

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1498521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701129600000",
    "number": "1033630363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "619 SW 6TH AVE.",
            "address_2": "5TH FL",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972098459",
            "telephone_number": "503-988-7468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 NE 8TH ST",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970307317",
            "telephone_number": "503-988-5155",
            "fax_number": "503-988-5185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILPONE",
        "first_name": "RYELY",
        "credential": "MSW, LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-27",
        "last_updated": "2023-11-28",
        "certification_date": "2023-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L7672",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "022959",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gresham, OR

Sources for this page

Verify at the official NPI Registry.