Impact NW

Primary specialty

Case Management AgencyTaxonomy code 251B00000X

Legal business name

IMPACT NW

Practice address

7211 SE 62ND Ave
Portland, OR 97206

Phone

(503) 721-6776

Fax

(971) 254-8969

NPI assigned

Jul 15, 2010

Last updated

Aug 17, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Amanda Lee Adams

Title

LTK Project Coordinator

Phone

(541) 227-8888

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Portland Impact, Inc Former legal business name

Tax ID family

Impact NW2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Impact NW

  • Case Management Agency
  • Portland, OR
  • NPI 1417495862
  NPD tax ID

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/21008/brand/1/csg/1/fhir/r4

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Erin Fanshier, MSW

  • Social Worker
  • Portland, OR
  • NPI 1740632090
  NPD (past)

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

{
    "created_epoch": "1279152000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1502928000000",
    "number": "1053624387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 33530",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972923530",
            "telephone_number": "503-294-7400",
            "fax_number": "503-802-0046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7211 SE 62ND AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97206",
            "telephone_number": "503-721-6776",
            "fax_number": "971-254-8969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPACT NW",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-15",
        "last_updated": "2017-08-17",
        "status": "A",
        "authorized_official_last_name": "ADAMS",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "LTK PROJECT COORDINATOR",
        "authorized_official_telephone_number": "541-227-8888",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500721499",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Portland Impact, Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Bizuayehu Geremew Imiru
• Amy Elizabeth Imkamp, M.S.,CCC-SLP
• Immersion Enterprises LLC
• Impact Chiropractic
• Impact Chiropractic
• Impact NW
• Brandie Lynne Imperial, LCSW, CADCI
• In Between Therapy Collective LLC (in between therapy collective)
• In Context, LLC
• In Home Neuro Studies LLC

• Case Management Agency in Portland, OR
• Providers in Portland, OR by specialty
• Case Management Agency in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2017; 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.