NPIMap

Organization Active NPI

Wandering Stone Acupuncture LLC

  • Acupuncturist
  • Portland, OR
National Provider Identifier
1033766001
Registry record updated Aug 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
AcupuncturistTaxonomy code 171100000X
Legal business name
WANDERING STONE ACUPUNCTURE LLC
Practice address
1524 NE Hancock St Apt 2
Portland, OR 97212-4472
Phone
(360) 223-4533
NPI assigned
Aug 23, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2019

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

Authorized official

Name
Holly Ann Polinkus, LAC
Title
Lac
Phone
(360) 223-4533

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
AcupuncturistGroup: 193400000X SINGLE SPECIALTY GROUP 171100000X Primary

Addresses

Primary practice location

1524 NE Hancock St Apt 2
Portland, OR 97212-4472

Mailing address

1524 NE Hancock St Apt 2
Portland, OR 97212-4472
Phone (360) 223-4533

Other identifiers 1

IdentifierTypeStateIssuer
500759468MedicaidOR

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1566518400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1566518400000",
    "number": "1033766001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1524 NE HANCOCK ST APT 2",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972124472",
            "telephone_number": "360-223-4533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1524 NE HANCOCK ST APT 2",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972124472",
            "telephone_number": "360-223-4533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WANDERING STONE ACUPUNCTURE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-23",
        "last_updated": "2019-08-23",
        "status": "A",
        "authorized_official_last_name": "POLINKUS",
        "authorized_official_first_name": "HOLLY",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "LAC",
        "authorized_official_telephone_number": "360-223-4533",
        "authorized_official_credential": "LAC"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Acupuncturist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500759468",
            "state": "OR"
        }
    ],
    "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 Aug 23, 2019; 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.