Carlos Thomas Benson Martinez

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

License

THW000003795 Issued in OR

Practice address

12655 SW Center St Ste 100
Beaverton, OR 97005-1600

Phone

(617) 301-0447

Fax

(503) 828-3401

NPI assigned

Oct 4, 2019

Last updated

Oct 4, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1570147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570147200000",
    "number": "1205477783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12577 SE RIVER RD APT 139",
            "city": "MILWAUKIE",
            "state": "OR",
            "postal_code": "972228007",
            "telephone_number": "617-301-0447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12655 SW CENTER ST STE 100",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970051600",
            "telephone_number": "617-301-0447",
            "fax_number": "503-828-3401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENSON MARTINEZ",
        "first_name": "CARLOS",
        "middle_name": "THOMAS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-10-04",
        "last_updated": "2019-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "OR",
            "license": "THW000003795",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "THW CERTIFICATION #",
            "identifier": "THW000003795",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "carlosbm@wolfpackcts.org",
            "affiliation": "N",
            "endpointDescription": "Work Email",
            "address_1": "12655 SW Center St Ste 100",
            "city": "Beaverton",
            "state": "OR",
            "country_code": "US",
            "postal_code": "970051600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Mandy Benfit, LPN
• Corey D Benjamin, CADC, CRM, QMHA
• Rachel Bennett
• Brett A Bennink, PSY.D.
• McCall Bennion
• Janis Fujimoto Benson, OTR/L
• Tyanna Benson, LCSW
• Raven Bentley
• Carly Bento
• Benz Bones and Jints PC

• Peer Specialist in Beaverton, OR
• Providers in Beaverton, OR by specialty
• Peer Specialist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2019; 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.