Active NPI
Jeffrey Randall
- Clinical Social Worker
- Portland, OR
National Provider Identifier
1053782656
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- L7994
- Practice address
- 3500 NE MLK Blvd Ste 200
Portland, OR 97212-2093 - Phone
- (503) 327-8205
- NPI assigned
- Oct 8, 2015
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Clinical Social Worker | 1041C0700X | L7994 | OR | Primary |
Addresses
Primary practice location
3500 NE MLK Blvd Ste 200
Portland, OR 97212-2093
Mailing address
PO Box 82819
Portland, OR 97282-0819
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 1, 2024 through Apr 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1444262400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1552348800000",
"number": "1053782656",
"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"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3500 NE MLK BLVD STE 200",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972122093",
"telephone_number": "503-327-8205"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RANDALL",
"first_name": "JEFFREY",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-10-08",
"last_updated": "2019-03-12",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "OR",
"license": "L7994",
"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 Mar 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.