Active NPI
Ria Jenae Sisk, CRM
- Peer Specialist
- Portland, OR
National Provider Identifier
1184127763
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- License
- 16-CRM-153
- Practice address
- 10564 SE Washington St
Portland, OR 97216-2809 - Phone
- (503) 888-3656
- NPI assigned
- Mar 9, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | 16-CRM-153 | OR | Primary |
Addresses
Primary practice location
10564 SE Washington St
Portland, OR 97216-2809
Mailing address
200 S Longview Way Apt 68
Oregon City, OR 97045-1356
Phone (503) 888-3656
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 175T00000X | Medicaid | OR |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 16-CRM-153 | OR | MD | Peer Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1520553600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1520553600000",
"number": "1184127763",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 S LONGVIEW WAY APT 68",
"city": "OREGON CITY",
"state": "OR",
"postal_code": "970451356",
"telephone_number": "503-888-3656"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10564 SE WASHINGTON ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972162809",
"telephone_number": "503-888-3656"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SISK",
"first_name": "RIA",
"middle_name": "JENAE",
"credential": "CRM",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-03-09",
"last_updated": "2018-03-09",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "OR",
"license": "16-CRM-153",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "175T00000X",
"state": "OR"
}
],
"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 9, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.