Kevin C. Miyasato, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

5855 Issued in OR

Practice address

12725 SW Millikan Way
Suite 300
Beaverton, OR 97005-1678

Phone

(503) 906-7870

Fax

(503) 906-7871

NPI assigned

Aug 2, 2011

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• A Healing Intention, LLC

  • Community/Behavioral Health Agency
  • Beaverton, OR
  • NPI 1104236819
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1312243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1402012800000",
    "number": "1184902504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12725 SW MILLIKAN WAY",
            "address_2": "SUITE 300",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970051678",
            "telephone_number": "503-906-7870",
            "fax_number": "503-906-7871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12725 SW MILLIKAN WAY",
            "address_2": "SUITE 300",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970051678",
            "telephone_number": "503-906-7870",
            "fax_number": "503-906-7871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIYASATO",
        "first_name": "KEVIN",
        "middle_name": "C.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-08-02",
        "last_updated": "2014-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NV",
            "license": "00686",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NV",
            "license": "5214-S",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "5855",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500670052",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Misner
• Katharine Theresa Mitchell, FNP
• Savanah C Mitchell
• Mitra Gaspeed
• Jayli Chieko Miyamoto
• Jennifer Lynn Mlnarik, N.D.
• Joy Elizabeth Moceri, DNP
• Reza Moein Taghavi
• Irina Moga, DDS
• Michael Moga, LD

• Clinical Social Worker in Beaverton, OR
• Providers in Beaverton, OR by specialty
• Clinical Social Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.