Active NPI
Autumn L Roulan, LMT
- Contractor
- Portland, OR
National Provider Identifier
1083993091
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Contractor
- License
- OBMT6906
- Practice address
- 5835 NE Davis St.
Portland, OR 97213-0000 - Phone
- (503) 231-8818
- NPI assigned
- Aug 8, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | OBMT6906 | OR | Primary |
Addresses
Primary practice location
5835 NE Davis St.
Portland, OR 97213-0000
Mailing address
5835 NE Davis St.
Portland, OR 97213
Phone (503) 231-8818
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 |
|---|---|---|---|
| OBMT6906 | OR | MD | Contractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1312761600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1312761600000",
"number": "1083993091",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5835 NE DAVIS ST.",
"city": "PORTLAND",
"state": "OR",
"postal_code": "97213",
"telephone_number": "503-231-8818"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5835 NE DAVIS ST.",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972130000",
"telephone_number": "503-231-8818"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROULAN",
"first_name": "AUTUMN",
"middle_name": "L",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-08-08",
"last_updated": "2011-08-08",
"status": "A"
},
"taxonomies": [
{
"code": "171W00000X",
"taxonomy_group": "",
"desc": "Contractor",
"state": "OR",
"license": "OBMT6906",
"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 Aug 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.