Individual provider Active NPI

William Bradley Hamlin, LAC

  • Acupuncturist
  • Portland, OR
National Provider Identifier
1043632706
Registry record updated Jan 15, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
AcupuncturistTaxonomy code 171100000X
License
AC01286 Issued in OR
Practice address
914 SW 11TH Ave
Portland, OR 97205-2001
Phone
(503) 765-5333
Fax
(888) 495-4549
NPI assigned
Jan 15, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acupuncturist 171100000X AC01286 OR Primary

Addresses

Primary practice location

914 SW 11TH Ave
Portland, OR 97205-2001

Mailing address

914 SW 11TH Ave
Portland, OR 97205-2001
Phone (503) 765-5333

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

LicenseStateTypeSpecialty
AC01286ORMDAcupuncturist

Practice roles

OrganizationSpecialtyStatusNew patients
Revivanation LLC Acupuncturist Past Accepting new patients
Inner Gate Acupuncture LLC Acupuncturist PastSince Sep 1, 2022 Accepting new patients

Organizations & group practices 2

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": "1389744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1389744000000",
    "number": "1043632706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "914 SW 11TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972052001",
            "telephone_number": "503-765-5333",
            "fax_number": "888-495-4549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "914 SW 11TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972052001",
            "telephone_number": "503-765-5333",
            "fax_number": "888-495-4549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAMLIN",
        "first_name": "WILLIAM",
        "middle_name": "BRADLEY",
        "credential": "LAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-01-15",
        "last_updated": "2014-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "OR",
            "license": "AC01286",
            "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 Jan 15, 2014; 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.