Active NPI
Ray A. Shellmire, LCSW
- Mental Health Counselor
- Portland, OR
National Provider Identifier
1043428386
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128a(1) exclusion effective Oct 20, 2020.
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 2376
- Practice address
- 4134 N Vancouver Ave
Suite 102
Portland, OR 97217-2900 - Phone
- (503) 331-2548
- Fax
- (503) 331-2549
- NPI assigned
- May 18, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 2376 | OR | Primary |
Addresses
Primary practice location
4134 N Vancouver Ave
Suite 102
Portland, OR 97217-2900
Mailing address
872 NE 166TH Ave
Portland, OR 97230-6164
Phone (503) 288-2767
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 167863 SC | Other | OR | OMAP |
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
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2376 | OR | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179446400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1043428386",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "872 NE 166TH AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972306164",
"telephone_number": "503-288-2767",
"fax_number": "503-288-2767"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4134 N VANCOUVER AVE",
"address_2": "SUITE 102",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972172900",
"telephone_number": "503-331-2548",
"fax_number": "503-331-2549"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHELLMIRE",
"first_name": "RAY",
"middle_name": "A.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "OR",
"license": "2376",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OMAP",
"identifier": "167863 SC",
"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 Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.