Individual provider Active NPI

Kristy Regan

  • Clinical Social Worker
  • Portland, OR
National Provider Identifier
1124779442
Registry record updated May 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
L16422 Issued in OR
Practice address
2901 E Burnside St
Portland, OR 97214-1831
Phone
(503) 953-0310
NPI assigned
Jan 18, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 12, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X
Clinical Social Worker 1041C0700X L16422 OR Primary
Nutritionist 133N00000X

Addresses

Primary practice location

2901 E Burnside St
Portland, OR 97214-1831

Mailing address

7515 Falcon Crest Dr # 200
Redmond, OR 97756-5014

Other practice location 1

2130 SW Jefferson St Ste 200
Portland, OR 97201-7710
Phone (971) 266-6910

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250523002625 OR Practitioner - Clinical Social Worker 2769901560 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2022
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

7515 Falcon Crest Dr
Suite 200
Redmond, OR 97756-5014

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Brightways Counseling Group LLC Clinical CurrentSince Apr 16, 2025 Accepting new patients
Bright Horizons Psychiatric Group LLC CurrentSince May 18, 2025 Accepting new patients

Locations

2901 E Burnside St
Portland, OR 97214
Phone (503) 230-9875

7515 Falcon Crest Dr
#200
Redmond, OR 97756

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.

NPI Registry JSON

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

{
    "created_epoch": "1642464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747008000000",
    "number": "1124779442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7515 FALCON CREST DR # 200",
            "city": "REDMOND",
            "state": "OR",
            "postal_code": "977565014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2901 E BURNSIDE ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972141831",
            "telephone_number": "503-953-0310"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2130 SW Jefferson St Ste 200",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972017710",
            "country_code": "US",
            "telephone_number": "971-266-6910",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "REGAN",
        "first_name": "KRISTY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-18",
        "last_updated": "2025-05-12",
        "certification_date": "2025-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L16422",
            "primary": true
        },
        {
            "code": "133N00000X",
            "taxonomy_group": "",
            "desc": "Nutritionist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.