Active NPI
Jodie Lynn Pereira, QMHA
- Case Manager/Care Coordinator
- Newport, OR
National Provider Identifier
1083102461
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Manager/Care Coordinator
- Practice address
- 51 SW Lee St
Newport, OR 97365-3823 - Phone
- (541) 574-5960
- NPI assigned
- May 1, 2018
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | THW1458 | OR | |
| Case Manager/Care Coordinator | 171M00000X | Primary |
Addresses
Primary practice location
51 SW Lee St
Newport, OR 97365-3823
Mailing address
36 SW Nye St
Newport, OR 97365-3821
Phone (541) 265-0445
Other practice location 1
764 101 S
Yachats, OR 97498
Phone (541) 901-1175
Other practice location 2
36 SW Nye St
Newport, OR 97365-3821
Phone (541) 265-0445
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 500776143 | Medicaid | OR |
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 |
|---|---|---|---|
| THW1458 | OR | MD | Peer Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1525132800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1591142400000",
"number": "1083102461",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "36 SW NYE ST",
"city": "NEWPORT",
"state": "OR",
"postal_code": "973653821",
"telephone_number": "541-265-0445"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "51 SW LEE ST",
"city": "NEWPORT",
"state": "OR",
"postal_code": "973653823",
"telephone_number": "541-574-5960"
}
],
"practiceLocations": [
{
"address_1": "764 101 S",
"address_purpose": "LOCATION",
"city": "Yachats",
"state": "OR",
"postal_code": "97498",
"country_code": "US",
"telephone_number": "541-901-1175",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "36 SW Nye St",
"address_purpose": "LOCATION",
"city": "Newport",
"state": "OR",
"postal_code": "973653821",
"country_code": "US",
"telephone_number": "541-265-0445",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PEREIRA",
"first_name": "JODIE",
"middle_name": "LYNN",
"name_prefix": "Ms.",
"credential": "QMHA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-05-01",
"last_updated": "2020-06-03",
"certification_date": "2020-06-03",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "OR",
"license": "THW1458",
"primary": false
},
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "500776143",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Newport, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.