NPIMap

Organization Active NPI

Watershed Community Wellness LLC

Doing business as Watershed Wellness

  • Acupuncturist
  • Astoria, OR
National Provider Identifier
1114460748
Registry record updated Nov 30, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
AcupuncturistTaxonomy code 171100000X
License
AC150225 Issued in OR
Legal business name
WATERSHED COMMUNITY WELLNESS LLC
Doing business as
Watershed Wellness
Practice address
1490 Commercial St
202
Astoria, OR 97103-3800
Phone
(503) 974-0914
Fax
(888) 972-3725
NPI assigned
Nov 30, 2016
Last updated
Nov 30, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
WATERSHED COMMUNITY WELLNESS LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 30, 2016

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

Authorized official

Name
Eric Grey
Title
Owner / Member
Phone
(503) 806-5174

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Acupuncturist 171100000X AC150225 OR Primary
Mechanotherapist 172M00000X 12190 OR

Addresses

Primary practice location

1490 Commercial St
202
Astoria, OR 97103-3800

Mailing address

1490 Commercial St
202
Astoria, OR 97103-3800
Phone (503) 974-0914

Other names 1

  • Watershed Wellness Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Watershed Community Wellness LLC2 organizations share this tax ID, including this one
Part of
Watershed Community Wellness LLC

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 3

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": "1480464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480464000000",
    "number": "1114460748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1490 COMMERCIAL ST",
            "address_2": "202",
            "city": "ASTORIA",
            "state": "OR",
            "postal_code": "971033800",
            "telephone_number": "503-974-0914",
            "fax_number": "888-972-3725"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1490 COMMERCIAL ST",
            "address_2": "202",
            "city": "ASTORIA",
            "state": "OR",
            "postal_code": "971033800",
            "telephone_number": "503-974-0914",
            "fax_number": "888-972-3725"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATERSHED COMMUNITY WELLNESS LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WATERSHED COMMUNITY WELLNESS LLC",
        "enumeration_date": "2016-11-30",
        "last_updated": "2016-11-30",
        "status": "A",
        "authorized_official_last_name": "GREY",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "OWNER / MEMBER",
        "authorized_official_telephone_number": "503-806-5174"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "OR",
            "license": "AC150225",
            "primary": true
        },
        {
            "code": "172M00000X",
            "taxonomy_group": "",
            "desc": "Mechanotherapist",
            "state": "OR",
            "license": "12190",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Watershed Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Astoria, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.