Brent D Fisk, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

3093 Issued in OR

Practice address

1003 Providence Dr Ste 110
Newberg, OR 97132-7521

Phone

(503) 537-5900

NPI assigned

Jan 23, 2015

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 7

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Salem HealthGroup PAC ID 8628986668, 470 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: bfisk511334@oc.providencedirect.org

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.

• Salem Health

  • General Acute Care Hospital
  • Salem, OR
  • NPI 1265431829
  Medicare reassignment Care Compare group NPD
• Mid Valley Counseling Center Inc

  • Clinical Psychologist
  • Salem, OR
  • NPI 1407039308
  Medicare reassignment
• Salem Health

  • Durable Medical Equipment & Medical Supplies
  • Keizer, OR
  • NPI 1487434775
  NPD

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

{
    "created_epoch": "1421971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601942400000",
    "number": "1124418561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3158",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083158",
            "telephone_number": "503-215-6494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1003 PROVIDENCE DR STE 110",
            "city": "NEWBERG",
            "state": "OR",
            "postal_code": "971327521",
            "telephone_number": "503-537-5900"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "672 NE Evans St",
            "address_purpose": "LOCATION",
            "city": "McMinnville",
            "state": "OR",
            "postal_code": "97128",
            "country_code": "US",
            "telephone_number": "503-434-7505",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FISK",
        "first_name": "BRENT",
        "middle_name": "D",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-01-23",
        "last_updated": "2020-10-06",
        "certification_date": "2020-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "OR",
            "license": "3093",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bfisk511334@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "1000 N Providence Dr Ste 120",
            "city": "Newberg",
            "state": "OR",
            "country_code": "US",
            "postal_code": "971327582",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bfisk511334@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "1000 N Providence Dr Ste 210",
            "city": "Newberg",
            "state": "OR",
            "country_code": "US",
            "postal_code": "971327582",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bfisk511334@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "1003 N Providence Dr Ste 210",
            "city": "Newberg",
            "state": "OR",
            "country_code": "US",
            "postal_code": "971327523",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bfisk511334@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "110 Center Ave",
            "city": "Molalla",
            "state": "OR",
            "country_code": "US",
            "postal_code": "970388134",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bfisk511334@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "12345 SW Horizon Blvd Ste 57",
            "city": "Beaverton",
            "state": "OR",
            "country_code": "US",
            "postal_code": "970079475",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bfisk511334@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "200 S Hazel Dell Way",
            "city": "Canby",
            "state": "OR",
            "country_code": "US",
            "postal_code": "970137829",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bfisk511334@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "29345 SW Town Center Loop E Ste 110",
            "city": "Wilsonville",
            "state": "OR",
            "country_code": "US",
            "postal_code": "970708486",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Shaeli Ferguson, M.A., LPC
• First Step Adolescent & Adult Treatment Center
• Matthew Charles Fischer, M.D.
• Courtney Marie Fisher
• Richard M Fisher, MD
• Jonathan D Fisk, PA-C
• Sarah Grace Fitch, AU.D
• Valerie Yuko Fitzgerald, LMT
• Rebecca Marie Flatt, MSW
• Kayleigh Brianna Flint

• Clinical Psychologist in Newberg, OR
• Providers in Newberg, OR by specialty
• Clinical Psychologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.