Individual provider Active NPI

James Samuel Shoemaker, LCSW

  • Clinical Social Worker
  • Portland, OR
National Provider Identifier
1083337257
Registry record updated Sep 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
L12412 Issued in OR
Practice address
1130 NW 22ND Ave Ste 220
Portland, OR 97210-2969
Phone
(503) 413-8988
Fax
(503) 413-5629
NPI assigned
Sep 22, 2022
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 22, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X L12412 OR Primary

Addresses

Primary practice location

1130 NW 22ND Ave Ste 220
Portland, OR 97210-2969

Mailing address

1544 SE Hawthorne Blvd Apt 3
Portland, OR 97214-3976
Phone (616) 822-1637

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221206000527 OR Practitioner - Clinical Social Worker 1456720986 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

2801 N Gantenbein Ave
Portland, OR 97227-1623
Phone (503) 413-2042

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.62 of 100Reported as apm
Quality
77.21
Promoting interoperability
99.06
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
94.62 of 100Reported as apm
Quality
77.21
Promoting interoperability
99.06
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Legacy Emanuel Hospital & Health Center Current Accepting new patients
Legacy Emanuel Hospital & Health Center CurrentSince Feb 18, 2024 Accepting new patients
Legacy Clinics LLC CurrentSince Nov 21, 2022 Accepting new patients
Legacy Clinics LLC CurrentSince Nov 21, 2022 Accepting new patients
Legacy Emanuel Hospital & Health Center CurrentSince Feb 18, 2024 Accepting new patients

Locations

2801 N Gantenbein Ave
Portland, OR 97227
Phone (503) 413-2200

1130 NW 22nd Ave
Ste 220
Portland, OR 97210
Phone (503) 413-4134

1919 NW Lovejoy St
Portland, OR 97209
Phone (503) 415-5600

Organizations & group practices 5

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

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1663804800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663804800000",
    "number": "1083337257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1544 SE HAWTHORNE BLVD APT 3",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972143976",
            "telephone_number": "616-822-1637"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1130 NW 22ND AVE STE 220",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972102969",
            "telephone_number": "503-413-8988",
            "fax_number": "503-413-5629"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHOEMAKER",
        "first_name": "JAMES",
        "middle_name": "SAMUEL",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-09-22",
        "last_updated": "2022-09-22",
        "certification_date": "2022-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L12412",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.