Individual provider Active NPI

Carli R Rose

  • Case Manager/Care Coordinator
  • Port Townsend, WA
National Provider Identifier
1124734710
Registry record updated Jan 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Manager/Care CoordinatorTaxonomy code 171M00000X
Practice address
884 W Park Ave
Port Townsend, WA 98368-2273
Phone
(360) 385-0321
NPI assigned
Jan 26, 2023
Sex
Female
Sole proprietor
No

Organizations & group practices 2

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.

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

Practice roles

OrganizationSpecialtyStatusNew patients
Jefferson Community Counseling Center CurrentSince Jan 29, 2023 Accepting new patients
Madrona Institute of Washington PastSince Jan 29, 2023 Accepting new patients

Locations

884 W Park Ave
Port Townsend, WA 98368
Phone 3603850321201

Interoperability endpoints

  • FHIR API: https://api.qualifacts.org/api/fhir/discoverybh/r4/

Specialties & licenses 2

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Peer Specialist 175T00000X
Case Manager/Care Coordinator 171M00000X Primary

Addresses

NPPES NPI Registry

Primary practice location

884 W Park Ave
Port Townsend, WA 98368-2273

Mailing address

PO Box 565
Port Townsend, WA 98368-0565
Phone (360) 385-0321

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jan 26, 2023.

{
    "created_epoch": "1674691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674691200000",
    "number": "1124734710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 565",
            "city": "PORT TOWNSEND",
            "state": "WA",
            "postal_code": "983680565",
            "telephone_number": "360-385-0321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "884 W PARK AVE",
            "city": "PORT TOWNSEND",
            "state": "WA",
            "postal_code": "983682273",
            "telephone_number": "360-385-0321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSE",
        "first_name": "CARLI",
        "middle_name": "R",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-01-26",
        "last_updated": "2023-01-26",
        "certification_date": "2023-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Townsend, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2023; 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.