NPIMap

Organization Active NPI

Fifth Corner Academy

  • Child & Adolescent Psychiatry Physician
  • McMinnville, OR
National Provider Identifier
1033753231
Registry record updated Mar 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X
Legal business name
FIFTH CORNER ACADEMY
Practice address
1900 NE Highway 99W Ste K
McMinnville, OR 97128-2757
Phone
(503) 472-4511
Fax
(503) 714-6306
NPI assigned
Oct 30, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2020

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

Authorized official

Name
Mrs. Roxanne Franklin Wilson, BA, QMHA, PSSNPI 1427692623
Title
President/Program Administrator
Phone
(503) 714-6306

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 10

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Nutrition Education NutritionistGroup: 193200000X MULTI-SPECIALTY GROUP 133NN1002X
Registered NurseGroup: 193200000X MULTI-SPECIALTY GROUP 163W00000X
Case Manager/Care CoordinatorGroup: 193200000X MULTI-SPECIALTY GROUP 171M00000X
DriverGroup: 193200000X MULTI-SPECIALTY GROUP 172A00000X
Research Study SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 1744R1102X
Health EducatorGroup: 193200000X MULTI-SPECIALTY GROUP 174H00000X
Peer SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 175T00000X
Child & Adolescent Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0804X Primary
Prevention ProfessionalGroup: 193200000X MULTI-SPECIALTY GROUP 405300000X

Addresses

Primary practice location

1900 NE Highway 99W Ste K
McMinnville, OR 97128-2757

Mailing address

650 NE 2ND St Unit 133
McMinnville, OR 97128-4762
Phone (503) 472-4511

Other practice location 1

1900 NE Highway 99W Ste M
McMinnville, OR 97128-2757
Phone (503) 714-6306

Other identifiers 1

IdentifierTypeStateIssuer
1851475099MedicaidOR

Other names 1

  • Fifth Corner Community Services Doing business as

National Provider Directory

National Provider Directory

Locations

1900 NE Highway 99W
Ste K
McMinnville, OR 97128
Phone (503) 714-6306

650 NE 2nd St
Unit 133
McMinnville, OR 97128

1900 NE Highway 99W
Ste M
McMinnville, OR 97128
Phone (503) 714-6306

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1572393600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585353600000",
    "number": "1033753231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "650 NE 2ND ST UNIT 133",
            "city": "MCMINNVILLE",
            "state": "OR",
            "postal_code": "971284762",
            "telephone_number": "503-472-4511",
            "fax_number": "503-714-6306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 NE HIGHWAY 99W STE K",
            "city": "MCMINNVILLE",
            "state": "OR",
            "postal_code": "971282757",
            "telephone_number": "503-472-4511",
            "fax_number": "503-714-6306"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1900 NE Highway 99W Ste M",
            "address_purpose": "LOCATION",
            "city": "McMinnville",
            "state": "OR",
            "postal_code": "971282757",
            "country_code": "US",
            "telephone_number": "503-714-6306",
            "fax_number": "503-714-6306",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FIFTH CORNER ACADEMY",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-30",
        "last_updated": "2020-03-28",
        "certification_date": "2020-03-28",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "ROXANNE",
        "authorized_official_middle_name": "FRANKLIN",
        "authorized_official_title_or_position": "PRESIDENT/PROGRAM ADMINISTRATOR",
        "authorized_official_telephone_number": "503-714-6306",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "BA, QMHA, PSS"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133NN1002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nutritionist, Nutrition, Education",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "172A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Driver",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1744R1102X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist, Research Study",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "174H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Health Educator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "175T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Peer Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "405300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Prevention Professional",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1851475099",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fifth Corner Community Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in McMinnville, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.