Active NPI
Mark Clegg, LMT
- Massage Therapist
- Portland, OR
National Provider Identifier
1205051679
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 6717
- Practice address
- 2031 E Burnside St
Portland, OR 97214-1649 - Phone
- (503) 224-2100
- Fax
- (503) 224-2129
- NPI assigned
- Apr 13, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 6717 | OR | Primary |
Addresses
Primary practice location
2031 E Burnside St
Portland, OR 97214-1649
Mailing address
3200 SE 21St Ave
Portland, OR 97202-2318
Phone (503) 516-3160
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 |
|---|---|---|---|
| 6717 | OR | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Portland Chiropractic Group Inc | Massage Therapist | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176422400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1236902400000",
"number": "1205051679",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3200 SE 21ST AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972022318",
"telephone_number": "503-516-3160"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2031 E BURNSIDE ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972141649",
"telephone_number": "503-224-2100",
"fax_number": "503-224-2129"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLEGG",
"first_name": "MARK",
"name_prefix": "Mr.",
"credential": "LMT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-13",
"last_updated": "2009-03-13",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "OR",
"license": "6717",
"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 13, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.