Individual provider Active NPI

Marcus Eugene Sharpe, PSY.D.

  • Clinical Psychologist
  • Portland, OR
National Provider Identifier
1164592887
Registry record updated Jan 3, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSB30363 Issued in CA
Practice address
621 SW Alder St Ste 520
Avel Gordly Center for Healing (Ohsu)
Portland, OR 97205-3620
Phone
(503) 494-4745
Fax
(503) 494-4747
NPI assigned
Nov 9, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 3, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PSB30363 CA Primary

Addresses

Primary practice location

621 SW Alder St Ste 520
Avel Gordly Center for Healing (Ohsu)
Portland, OR 97205-3620

Mailing address

621 SW Alder Street, Suite 520
Avel Gordly Center for Healing (Ohsu)
Portland, OR 97205
Phone (503) 494-4745

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

State licenses

LicenseStateTypeSpecialty
PSB30363CAMDClinical Psychologist

NPI Registry JSON

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1325548800000",
    "number": "1164592887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "621 SW ALDER STREET, SUITE 520",
            "address_2": "AVEL GORDLY CENTER FOR HEALING (OHSU)",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97205",
            "telephone_number": "503-494-4745",
            "fax_number": "503-494-4747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 SW ALDER ST STE 520",
            "address_2": "AVEL GORDLY CENTER FOR HEALING (OHSU)",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972053620",
            "telephone_number": "503-494-4745",
            "fax_number": "503-494-4747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHARPE",
        "first_name": "MARCUS",
        "middle_name": "EUGENE",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-09",
        "last_updated": "2012-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSB30363",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "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 Jan 3, 2012; 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.