Carissa Ann Clark, LMT

Primary specialty

Massage TherapistTaxonomy code 225700000X

Practice address

2188 SW Park PL Ste 10
Portland, OR 97205-1100

Phone

(503) 568-1390

NPI assigned

Aug 25, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Carissa Ann Jobe Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• Working Class Wellness, LLC

  • Massage Therapist
  • Tigard, OR
  • NPI 1811606114
  NPD Authorized official
• Working Class Wellness, LLC

  • Massage Therapist
  • Kansas City, MO
  • NPI 1912611120
  NPD Authorized official
• Performance Bodywork LLC

  • Massage Therapist
  • Portland, OR
  • NPI 1811302607
  NPD (past)

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

{
    "created_epoch": "1629849600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629849600000",
    "number": "1194492371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2188 SW PARK PL STE 10",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972051100",
            "telephone_number": "503-568-1390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2188 SW PARK PL STE 10",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972051100",
            "telephone_number": "503-568-1390"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10029 SW Nimbus Ave Ste 230",
            "address_purpose": "LOCATION",
            "city": "Beaverton",
            "state": "OR",
            "postal_code": "970087110",
            "country_code": "US",
            "telephone_number": "503-372-6035",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "CARISSA",
        "middle_name": "ANN",
        "credential": "LMT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-25",
        "last_updated": "2021-08-25",
        "certification_date": "2021-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "OR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://performancebodywork.janeapp.com/",
            "affiliation": "N",
            "endpointDescription": "Jane App",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2188 SW Park Pl Ste 10",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972051100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "CARISSA",
            "last_name": "JOBE",
            "middle_name": "ANN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Benjamin Clark, CPO
• Brian D Clark, MD, PHD
• Brinton Carey Clark
• Caitlin Clark, MA
• Cara Dawn Clark, N.D.
• Carly Rene' Clark, RDH, EP
• Catherine Clark
• Chelsea Elizabeth Clark, FNP
• Christina Clark
• Christina Lynn Clark, LCSW

• Massage Therapist in Portland, OR
• Providers in Portland, OR by specialty
• Massage Therapist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2021; 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.