Active NPI
John Blomberg, PTA
- Community Health Worker
- Portland, OR
National Provider Identifier
1043682289
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- License
- P1 60569439
- Practice address
- 9750 NE Glisan St
Portland, OR 97220-4449 - Phone
- (503) 256-3920
- NPI assigned
- Oct 27, 2015
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | P1 60569439 | WA | Primary |
Addresses
Primary practice location
9750 NE Glisan St
Portland, OR 97220-4449
Mailing address
11712 NW 38TH Ave
Vancouver, WA 98685-3550
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
| License | State | Type | Specialty |
|---|---|---|---|
| P1 60569439 | WA | MD | Community Health Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1445904000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1445904000000",
"number": "1043682289",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11712 NW 38TH AVE",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986853550"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9750 NE GLISAN ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972204449",
"telephone_number": "503-256-3920"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLOMBERG",
"first_name": "JOHN",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-10-27",
"last_updated": "2015-10-27",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "WA",
"license": "P1 60569439",
"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 Oct 27, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.