David Reid Davisworth II, QMHA

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

Practice address

51 SW Lee St
Newport, OR 97365-3823

Phone

(541) 574-5960

Fax

(541) 265-0601

NPI assigned

Mar 21, 2017

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• Columbacare Services

  • Adult Mental Health Clinic/Center
  • Portland, OR
  • NPI 1841718574
  NPD (past)
• County of Lincoln

  • Federally Qualified Health Center (FQHC)
  • Newport, OR
  • NPI 1992755664

  Case Manager/Care Coordinator

  NPD (past)

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

{
    "created_epoch": "1490054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1550707200000",
    "number": "1124559307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36 SW NYE ST",
            "city": "NEWPORT",
            "state": "OR",
            "postal_code": "973653821",
            "telephone_number": "541-265-4947",
            "fax_number": "541-265-4194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "51 SW LEE ST",
            "city": "NEWPORT",
            "state": "OR",
            "postal_code": "973653823",
            "telephone_number": "541-574-5960",
            "fax_number": "541-265-0601"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1368 Rockfish Valley Hwy",
            "address_purpose": "LOCATION",
            "city": "Nellysford",
            "state": "VA",
            "postal_code": "229583007",
            "country_code": "US",
            "telephone_number": "540-478-5229",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4422 NE Devils Lake Blvd",
            "address_purpose": "LOCATION",
            "city": "Lincoln City",
            "state": "OR",
            "postal_code": "973675000",
            "country_code": "US",
            "telephone_number": "541-265-4947",
            "fax_number": "541-994-0261",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "17720 NE Halsey St Ste B",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972306771",
            "country_code": "US",
            "telephone_number": "503-654-7654",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAVISWORTH II",
        "first_name": "DAVID",
        "middle_name": "REID",
        "name_prefix": "Mr.",
        "credential": "QMHA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-21",
        "last_updated": "2019-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "601157-449",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Darby Nicolette Davis, CMA
• Karlee Anne Davis, LPC
• Kristopher Davis, CRM
• Richard Viets Davis, MD
• Valerie Jean Davis
• Dawn Sly LCSW, Inc.
• Darcy De la Rosa, R.D., CDE
• Annalisa J Decina, LPC
• Jenny Kathleen Deen, R.D.H.
• Peggy Defazio

• Case Manager/Care Coordinator in Newport, OR
• Providers in Newport, OR by specialty
• Case Manager/Care Coordinator in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2019; 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.