Active NPI
Jesse Robertson
- Addiction (Substance Use Disorder) Counselor
- Medford, OR
National Provider Identifier
1114880481
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 25-CRM-5042
- Practice address
- 300 W Main St
Medford, OR 97501-2756 - Phone
- (541) 772-1777
- NPI assigned
- Dec 4, 2025
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 25-CRM-5042 | OR | Primary |
Addresses
Primary practice location
300 W Main St
Medford, OR 97501-2756
Mailing address
300 W Main St
Medford, OR 97501-2756
Phone (541) 772-1777
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 |
|---|---|---|---|
| 25-CRM-5042 | OR | MD | Peer Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1764806400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783468800000",
"number": "1114880481",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 W MAIN ST",
"city": "MEDFORD",
"state": "OR",
"postal_code": "975012756",
"telephone_number": "541-772-1777",
"fax_number": "541-724-2410"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 W MAIN ST",
"city": "MEDFORD",
"state": "OR",
"postal_code": "975012756",
"telephone_number": "541-772-1777"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTSON",
"first_name": "JESSE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-12-04",
"last_updated": "2026-07-08",
"certification_date": "2026-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "OR",
"license": "25-CRM-5042",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Medford, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.