Jacob Russell Moss

Primary specialty

Social WorkerTaxonomy code 104100000X

Practice address

12636 SE Stark St
Plaza 125, BLDG J
Portland, OR 97233-1058

Phone

(503) 253-4600

Fax

(503) 253-4609

NPI assigned

Oct 13, 2010

Last updated

Jul 24, 2014By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Elevate Wellness Counseling LLC

  • Clinical Social Worker
  • Portland, OR
  • NPI 1700686557
  NPD Authorized official
• Eugene Therapy LLC

  dba Oregon Counseling

  • Psychiatric/Mental Health Nurse Practitioner
  • Eugene, OR
  • NPI 1295065530
  NPD (past)

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

{
    "created_epoch": "1286928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1406160000000",
    "number": "1053621912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 82819",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972820819",
            "telephone_number": "801-233-5405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12636 SE STARK ST",
            "address_2": "PLAZA 125, BLDG J",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972331058",
            "telephone_number": "503-253-4600",
            "fax_number": "503-253-4609"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOSS",
        "first_name": "JACOB",
        "middle_name": "RUSSELL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-10-13",
        "last_updated": "2014-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lorena Mosqueda
• Moss and Moon Bodywork
• Abby Marie Moss
• Audrey Rock Moss, L.AC., LMT
• Benjamin Moss, MD
• Jennifer Melissa Moss, MFT
• Josha Moss, PTA
• Kelsey-Jo Audrey Moss, CPNP-PC
• Lenore Marie Moss
• Lori Noel Moss, RN, BSN, CCRN

• Social Worker in Portland, OR
• Providers in Portland, OR by specialty
• Social Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 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.