NPIMap

Organization Active NPI

Mindful Health Northwest LLC

  • Psychiatry Physician
  • Portland, OR
National Provider Identifier
1144993015
Registry record updated Sep 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
MINDFUL HEALTH NORTHWEST LLC
Practice address
811 E Burnside St Ste 217
Portland, OR 97214-1231
Phone
(503) 476-1189
Fax
(866) 650-8756
NPI assigned
Jul 27, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2021

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

Authorized official

Name
Scott Christensen, MDNPI 1871025197
Title
Member
Phone
(503) 476-1189

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X Primary

Addresses

Primary practice location

811 E Burnside St Ste 217
Portland, OR 97214-1231

Mailing address

811 E Burnside St Ste 217
Portland, OR 97214-1231
Phone (503) 476-1189

Other identifiers 1

IdentifierTypeStateIssuer
MD192693OtherOROREGON STATE MEDICAL LICENSE

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://ehr.charmtracker.com/api/ehr/v1/fhir

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211102003287 OR Part B Supplier - Clinic/Group Practice 0648668111 Receives reassigned benefits from 4 practitioners
Practice locations: Beaverton, OR

National Provider Directory

National Provider Directory

Locations

15455 NW Greenbrier Pkwy
Ste 120
Beaverton, OR 97006
Phone (503) 476-1189

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1627344000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631836800000",
    "number": "1144993015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "811 E BURNSIDE ST STE 217",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972141231",
            "telephone_number": "503-476-1189",
            "fax_number": "866-650-8756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "811 E BURNSIDE ST STE 217",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972141231",
            "telephone_number": "503-476-1189",
            "fax_number": "866-650-8756"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINDFUL HEALTH NORTHWEST LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-27",
        "last_updated": "2021-09-17",
        "certification_date": "2021-09-17",
        "status": "A",
        "authorized_official_last_name": "CHRISTENSEN",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "503-476-1189",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OREGON STATE MEDICAL LICENSE",
            "identifier": "MD192693",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://ehr.charmtracker.com/api/ehr/v1/fhir",
            "affiliation": "N",
            "endpointDescription": "API Root Endpoint",
            "address_1": "811 E Burnside St Ste 217",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972141231",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.