Individual provider Active NPI

Erick Frederick Rivera, LCSW

  • Clinical Social Worker
  • Salem, OR
National Provider Identifier
1124436373
Registry record updated Dec 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
L6459 Issued in OR
Practice address
5125 Skyline Rd S
Salem, OR 97306-9427
Phone
(503) 588-5963
NPI assigned
Jul 31, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X L6459 OR Primary

Addresses

Primary practice location

5125 Skyline Rd S
Salem, OR 97306-9427

Mailing address

5125 Skyline Rd S
Salem, OR 97306-9427
Phone (503) 588-5963

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/interconnect-prodnwm/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, WA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20230808000999 OR Practitioner - Clinical Social Worker 1850753849 Reassigns benefits to 1 organization
I20230808001230 WA Practitioner - Clinical Social Worker 1850753849 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
L6459ORMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Jun 26, 2023 Accepting new patients
Kaiser Foundation Health Plan of the Northwest Current Accepting new patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Jun 26, 2023 Accepting new patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Jun 26, 2023 Accepting new patients

Locations

10100 SE Sunnyside Rd
Clackamas, OR 97015
Phone (503) 571-2946

7201 N Interstate Ave
Portland, OR 97217
Phone (503) 240-4051

2400 Lancaster Dr NE
Salem, OR 97305
Phone (503) 361-5400

5125 Skyline Rd S
Salem, OR 97306
Phone (503) 361-5400

1230 7th Ave
Longview, WA 98632
Phone (360) 575-4801

7101 NE 137th Ave
Vancouver, WA 98682
Phone (360) 418-6000

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1406764800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639958400000",
    "number": "1124436373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5125 SKYLINE RD S",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973069427",
            "telephone_number": "503-588-5963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5125 SKYLINE RD S",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973069427",
            "telephone_number": "503-588-5963"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIVERA",
        "first_name": "ERICK",
        "middle_name": "FREDERICK",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-07-31",
        "last_updated": "2021-12-20",
        "certification_date": "2021-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L6459",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/interconnect-prodnwm/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "5125 Skyline Rd S",
            "city": "Salem",
            "state": "OR",
            "country_code": "US",
            "postal_code": "973069427",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Salem, OR

Sources for this page

Verify at the official NPI Registry.