NPIMap

Individual provider Active NPI

Thomas Everette Imig, C.D.P.

  • Community Health Worker
  • Portland, OR
National Provider Identifier
1184017071
Registry record updated Mar 17, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health WorkerTaxonomy code 172V00000X
License
00004925 Issued in WA
Practice address
1030 NE Couch St.
Portland, OR 97232
Phone
(503) 239-8400
Fax
(503) 239-8407
NPI assigned
Mar 17, 2015
Last updated
Mar 17, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Worker 172V00000X 00004925 WA Primary

Addresses

Primary practice location

1030 NE Couch St.
Portland, OR 97232

Mailing address

1027 E. Burnside St.
Portland, OR 97214
Phone (503) 239-8400

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
00004925WAMDCommunity Health Worker

Practice roles

OrganizationSpecialtyStatusNew patients
University Professional Services Past Accepting new patients
University Professional Services Past Accepting new patients
Coda, Inc. PastSince Aug 13, 2019 Accepting new patients
Coda, Inc. PastSince Feb 9, 2020 Accepting new patients

Organizations & group practices 4

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": "1426550400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1426550400000",
    "number": "1184017071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1027 E. BURNSIDE ST.",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97214",
            "telephone_number": "503-239-8400",
            "fax_number": "503-269-8407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1030 NE COUCH ST.",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97232",
            "telephone_number": "503-239-8400",
            "fax_number": "503-239-8407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IMIG",
        "first_name": "THOMAS",
        "middle_name": "EVERETTE",
        "name_prefix": "Mr.",
        "credential": "C.D.P.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-03-17",
        "last_updated": "2015-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "WA",
            "license": "00004925",
            "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 Mar 17, 2015; 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.