NPIMap

Organization Active NPI

A Healing Intention, LLC

  • Community/Behavioral Health Agency
  • Beaverton, OR
National Provider Identifier
1104236819
Registry record updated Jun 6, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
5855 Issued in OR
Legal business name
A HEALING INTENTION, LLC
Practice address
12725 SW Millikan Way
Suite 300
Beaverton, OR 97005-1678
Phone
(503) 906-7870
Fax
(503) 906-7871
NPI assigned
May 2, 2014
Last updated
Jun 6, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2014

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

Authorized official

Name
Kevin C Miyasato, LCSWNPI 1184902504
Title
Owner
Phone
(503) 906-7870

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 5855 OR Primary

Addresses

Primary practice location

12725 SW Millikan Way
Suite 300
Beaverton, OR 97005-1678

Mailing address

12725 SW Millikan Way
Suite 300
Beaverton, OR 97005-1678
Phone (503) 906-7870

Other identifiers 1

IdentifierTypeStateIssuer
500670052MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140618000613 OR Part B Supplier - Clinic/Group Practice 9335363126 Receives reassigned benefits from 8 practitioners
Practice locations: Beaverton, OR

National Provider Directory

National Provider Directory

Locations

12655 SW Center St
Ste 320
Beaverton, OR 97005
Phone (503) 303-0304

Practitioners & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1398988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1402012800000",
    "number": "1104236819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12725 SW MILLIKAN WAY",
            "address_2": "SUITE 300",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970051678",
            "telephone_number": "503-906-7870",
            "fax_number": "503-906-7871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12725 SW MILLIKAN WAY",
            "address_2": "SUITE 300",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970051678",
            "telephone_number": "503-906-7870",
            "fax_number": "503-906-7871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "A HEALING INTENTION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-02",
        "last_updated": "2014-06-06",
        "status": "A",
        "authorized_official_last_name": "MIYASATO",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-906-7870",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "OR",
            "license": "5855",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500670052",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Beaverton, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2014; 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.

Verify at the official NPI Registry.