Active NPI
Markus Dickerson
- Adult Companion
- Portland, OR
National Provider Identifier
1215471040
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Companion
- Practice address
- 10300 SW Eastridge St
Portland, OR 97225-5004 - Phone
- (503) 944-5000
- NPI assigned
- Dec 13, 2016
- Last updated
- Dec 13, 2016
- 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 |
|---|---|---|---|---|
| Adult Companion | 372600000X | NU | Primary | |
| Behavior Technician | 106S00000X | NU |
Addresses
Primary practice location
10300 SW Eastridge St
Portland, OR 97225-5004
Mailing address
10300 SW Eastridge St
Portland, OR 97225-5004
Phone (503) 944-5000
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ubh of Oregon, LLC | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1481587200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1481587200000",
"number": "1215471040",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10300 SW EASTRIDGE ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972255004",
"telephone_number": "503-944-5000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10300 SW EASTRIDGE ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972255004",
"telephone_number": "503-944-5000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DICKERSON",
"first_name": "MARKUS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-12-13",
"last_updated": "2016-12-13",
"status": "A"
},
"taxonomies": [
{
"code": "372600000X",
"taxonomy_group": "",
"desc": "Adult Companion",
"state": "NU",
"license": null,
"primary": true
},
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "NU",
"license": null,
"primary": false
}
],
"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 Dec 13, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.