Individual provider Active NPI

Simon Faro Austin, MSW

  • Clinical Social Worker
  • Portland, OR
National Provider Identifier
1164619466
Registry record updated Sep 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
L5196 Issued in OR
Practice address
11740 SW 68TH Pkwy Ste 200
Portland, OR 97223-9058
Phone
(503) 804-5001
NPI assigned
Oct 1, 2007
Last updated
Sep 16, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X L5196 OR Primary

Addresses

Primary practice location

11740 SW 68TH Pkwy Ste 200
Portland, OR 97223-9058

Mailing address

2051 Kaen Rd Ste 367
Oregon City, OR 97045-4035
Phone (503) 742-5300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • 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
I20130225000136 OR Practitioner - Clinical Social Worker 0941455984 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mindful Therapy Group PCGroup PAC ID 4981872561, 654 clinicians

Practice addresses (Care Compare)

11740 SW 68TH Pkwy
Suite 200
Tigard, OR 97223-9058
Phone (971) 352-6984

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
L5196ORMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
County of Clackamas Office of County Auditor CurrentSince Dec 22, 2012 Accepting new patients
Mindful Therapy Group PC Clinical CurrentSince Jul 27, 2024 Accepting new patients
Clackamas County Current Accepting new patients
County of Clackamas Office of County Auditor Past Accepting new patients
Clackamas County Past Accepting new patients

Locations

110 Beavercreek Rd
Oregon City, OR 97045
Phone (503) 475-5558

2051 Kaen Rd
Ste 367
Oregon City, OR 97045
Phone (503) 742-5300

5440 SW Westgate Dr
Ste 350
Portland, OR 97221
Phone (503) 292-1100

11740 SW 68th Pkwy
Ste 200
Tigard, OR 97223
Phone (425) 477-4216

6505 216th St SW
Ste 100
Mountlake Terrace, WA 98043
Phone (425) 678-6463

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1191196800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726444800000",
    "number": "1164619466",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2051 KAEN RD STE 367",
            "city": "OREGON CITY",
            "state": "OR",
            "postal_code": "970454035",
            "telephone_number": "503-742-5300",
            "fax_number": "503-742-5979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11740 SW 68TH PKWY STE 200",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972239058",
            "telephone_number": "503-804-5001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AUSTIN",
        "first_name": "SIMON",
        "middle_name": "FARO",
        "name_prefix": "Mr.",
        "credential": "MSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-10-01",
        "last_updated": "2024-09-16",
        "certification_date": "2024-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L5196",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.