Active NPI
Corey D Benjamin, CADC, CRM, QMHA
- Addiction (Substance Use Disorder) Counselor
- Beaverton, OR
National Provider Identifier
1104699099
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- T-22-2156
- Practice address
- 3800 SW Cedar Hills Blvd Ste 170
Beaverton, OR 97005-2020 - Phone
- (503) 626-1800
- NPI assigned
- Nov 1, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 23-QMHA-R-4572 | OR | |
| Peer Specialist | 175T00000X | 23-CRM-2525 | OR | |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | T-22-2156 | OR | Primary |
Addresses
Primary practice location
3800 SW Cedar Hills Blvd Ste 170
Beaverton, OR 97005-2020
Mailing address
3800 SW Cedar Hills Blvd Ste 170
Beaverton, OR 97005-2020
Phone (503) 626-1800
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| T-22-2156 | Other | OR | MHACBO CADC |
| 23-CRM-2525 | Other | OR | MHACBO CRM |
| 500841524 | Medicaid | OR | |
| 23-QMHA-R-4572 | Other | OR | MHACBO QMHA |
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 |
|---|---|---|---|
| T-22-2156 | OR | MD | Addiction (Substance Use Disorder) Counselor |
| 23-QMHA-R-4572 | OR | MD | Mental Health Counselor |
| 23-CRM-2525 | OR | MD | Peer Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Solutions Group NW LLC | Addiction (Substance Use Disorder) | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Addiction (Substance Use Disorder) Counselor
- Beaverton, OR
- NPI 1497104004
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1698796800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1732752000000",
"number": "1104699099",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3800 SW CEDAR HILLS BLVD STE 170",
"city": "BEAVERTON",
"state": "OR",
"postal_code": "970052020",
"telephone_number": "503-626-1800"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3800 SW CEDAR HILLS BLVD STE 170",
"city": "BEAVERTON",
"state": "OR",
"postal_code": "970052020",
"telephone_number": "503-626-1800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENJAMIN",
"first_name": "COREY",
"middle_name": "D",
"credential": "CADC, CRM, QMHA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-11-01",
"last_updated": "2024-11-28",
"certification_date": "2024-11-28",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "OR",
"license": "23-QMHA-R-4572",
"primary": false
},
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "OR",
"license": "23-CRM-2525",
"primary": false
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "OR",
"license": "T-22-2156",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MHACBO CADC",
"identifier": "T-22-2156",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MHACBO CRM",
"identifier": "23-CRM-2525",
"state": "OR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "500841524",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MHACBO QMHA",
"identifier": "23-QMHA-R-4572",
"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 Nov 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.