Active NPI
Derek J Brimmer
- Mental Health Counselor
- Eugene, OR
National Provider Identifier
1194159186
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 499 W 4TH Ave
Eugene, OR 97401 - Phone
- (541) 686-1262
- NPI assigned
- Aug 26, 2013
- Last updated
- Jul 8, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | NU | Primary | |
| Social Worker | 104100000X | NU |
Addresses
Primary practice location
499 W 4TH Ave
Eugene, OR 97401
Mailing address
4061 Virginia Ave
Springfield, OR 97478-6472
Phone (541) 891-4485
Other practice location 1
2210 N Eldorado Ave
Klamath Falls, OR 97601-6418
Phone (541) 883-2537
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 930753926 | Other | OR | KYDC TAX ID # |
| 223354 | 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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1377475200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1531008000000",
"number": "1194159186",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4061 VIRGINIA AVE",
"city": "SPRINGFIELD",
"state": "OR",
"postal_code": "974786472",
"telephone_number": "541-891-4485"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "499 W 4TH AVE",
"city": "EUGENE",
"state": "OR",
"postal_code": "97401",
"telephone_number": "541-686-1262"
}
],
"practiceLocations": [
{
"address_1": "2210 N Eldorado Ave",
"address_purpose": "LOCATION",
"city": "Klamath Falls",
"state": "OR",
"postal_code": "976016418",
"country_code": "US",
"telephone_number": "541-883-2537",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BRIMMER",
"first_name": "DEREK",
"middle_name": "J",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-08-26",
"last_updated": "2018-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NU",
"license": null,
"primary": true
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NU",
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "KYDC TAX ID #",
"identifier": "930753926",
"state": "OR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "223354",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Eugene, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.