Active NPI
Lutheran Community Services NW
- Mental Health Counselor
- Bend, OR
National Provider Identifier
1093074882
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Legal business name
- LUTHERAN COMMUNITY SERVICES NW
- Practice address
- 2330 NE Division St Ste 9B
Bend, OR 97703-3530 - Phone
- (541) 323-5333
- Fax
- (541) 323-5854
- NPI assigned
- May 14, 2012
- Last updated
- Oct 15, 2019
- Organization subpart
- Yes
- Parent organization
- LUTHERAN COMMUNITY SERVICES NW
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Daniel Johnston
- Title
- Contract and Grant Administrator
- Phone
- (206) 816-3223
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | |||
| Mental Health Counselor | 101YM0800X | Primary | ||
| Community/Behavioral Health Agency | 251S00000X | |||
| Preferred Provider Organization | 305R00000X |
Addresses
Primary practice location
2330 NE Division St Ste 9B
Bend, OR 97703-3530
Mailing address
2545 N Eldorado Ave
Klamath Falls, OR 97601-6423
Phone (541) 883-3471
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093074882 | Other | OR | NPI NUMBER |
| 283234 | Medicaid | OR | |
| 500674445 | Medicaid | OR |
Other names 1
- Lutheran Community Services NW - Bend
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031210000871 | OR | Part B Supplier - Clinic/Group Practice | 1254237522 |
Receives reassigned benefits from 20 practitioners 4 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: McMinnville, OR; Portland, OR; Klamath Falls, OR |
Other NPIs on the same Medicare enrollment 3
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
dba Lcsnw
- Community/Behavioral Health Agency
- McMinnville, OR
- NPI 1255542106
O20031210000871
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Portland, OR
- NPI 1326056433
O20031210000871
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Klamath Falls, OR
- NPI 1720105489
O20031210000871
National Provider Directory
National Provider Directory- Part of
- Lutheran Community SVCS NW
Practitioners & affiliated clinicians
Practitioners 4
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.
-
- Psychiatric/Mental Health Nurse Practitioner
- Cottage Grove, OR
- NPI 1508254517
-
- Clinical Social Worker
- Bend, OR
- NPI 1316204803
Addiction (Substance Use Disorder)
-
- Psychiatric/Mental Health Nurse Practitioner
- Kansas City, MO
- NPI 1760917405
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1336953600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1571097600000",
"number": "1093074882",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2545 N ELDORADO AVE",
"city": "KLAMATH FALLS",
"state": "OR",
"postal_code": "976016423",
"telephone_number": "541-883-3471",
"fax_number": "541-883-3524"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2330 NE DIVISION ST STE 9B",
"city": "BEND",
"state": "OR",
"postal_code": "977033530",
"telephone_number": "541-323-5333",
"fax_number": "541-323-5854"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LUTHERAN COMMUNITY SERVICES NW",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "LUTHERAN COMMUNITY SERVICES NW",
"enumeration_date": "2012-05-14",
"last_updated": "2019-10-15",
"status": "A",
"authorized_official_last_name": "JOHNSTON",
"authorized_official_first_name": "DANIEL",
"authorized_official_title_or_position": "CONTRACT AND GRANT ADMINISTRATOR",
"authorized_official_telephone_number": "206-816-3223"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
},
{
"code": "251S00000X",
"taxonomy_group": "",
"desc": "Community/Behavioral Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "305R00000X",
"taxonomy_group": "",
"desc": "Preferred Provider Organization",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NPI NUMBER",
"identifier": "1093074882",
"state": "OR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "283234",
"state": "OR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "500674445",
"state": "OR"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Lutheran Community Services NW - Bend",
"code": "5",
"type": "Other Name"
},
{
"organization_name": "Lutheran Community Services NW - Bend",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Bend, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.