Christopher Karl Kruebbe, LCSW
Individual provider Active NPI Clinical Social Worker · Bay City, OR
NPI 1124288550 · NPPES record last updated May 16, 2014
Key facts
- NPI
- 1124288550
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- L5771 (OR)
- Practice address
- 9465 Third Street
Bay City, OR 97107 - Phone
- (541) 450-7991
- Fax
- (541) 472-0009
- NPI assigned
- Jun 10, 2008
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 9
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 2006
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Northwest Medical Foundation of Tillamook
Practice addresses (Care Compare)
1000 3Rd St
Tillamook, OR 97141-3430
Phone (503) 815-2260
1000 3Rd St
Tillamook, OR 97141-3497
1011 3Rd St
Tillamook, OR 97141-8292
Phone (503) 915-2280
10445 Neahkahnie Creek Rd
Adventist Health
Manzanita, OR 97130-0129
Phone (503) 815-2260
1100 3Rd St
Tillamook, OR 97141-3402
Phone (503) 815-2280
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130918000386 | OR | Practitioner - Clinical Social Worker | 6901040732 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11664 | LA | MD | Clinical Social Worker |
| 23581 | CA | MD | Adult Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northwest Medical Foundation of Tillamook | Current |
Accepting new patients | |
| Northwest Medical Foundation of Tillamook | Current |
Accepting new patients |
Locations
1000 3rd St
#M
Tillamook, OR 97141
Phone (503) 815-2260
1100 3rd St
Tillamook, OR 97141
Phone (503) 815-2116
1000 3rd St
Tillamook, OR 97141
Phone (503) 251-6129
1005 Cougar St
Vernonia, OR 97064
Phone (503) 429-0622
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 23581 | CA | |
| Clinical Social Worker | 1041C0700X | L5771 | OR | Yes |
| Clinical Social Worker | 1041C0700X | 11664 | LA |
Addresses
Primary practice location
9465 Third Street
Bay City, OR 97107
Mailing address
PO Box 3575
Bay City, OR 97107-3575
Phone (541) 450-7991
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| R171558 | Other | OR | MEDICARE PART B PTAN |
Other providers in Bay City, OR
All providers in Bay City, OR · Clinical Social Worker in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 16, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.