Active NPI
Brian James Boerma, M.A
- Professional Counselor
- Baker City, OR
National Provider Identifier
1235335290
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- C5728
- Practice address
- 3425 13TH St
Baker City, OR 97814-1340 - Phone
- (541) 523-7400
- Fax
- (541) 523-4927
- NPI assigned
- Jun 26, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 6401010452 | MI | |
| Professional Counselor | 101YP2500X | C5728 | OR | Primary |
Addresses
Primary practice location
3425 13TH St
Baker City, OR 97814-1340
Mailing address
3425 13TH St
Baker City, OR 97814-1340
Phone (541) 523-7400
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 500794921 | Medicaid | OR | |
| B176375 | Other | OR | ODL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Undefined Non-Physician Type (Specify)
- Education
- Other, 2007
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
3425 13TH St
Baker City, OR 97814-1340
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6401010452 | MI | MD | Professional Counselor |
| C5728 | OR | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| New Directions Northwest, Inc | Current | 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.
-
- Community/Behavioral Health Agency
- Baker City, OR
- NPI 1235124462
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182816000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1659052800000",
"number": "1235335290",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3425 13TH ST",
"city": "BAKER CITY",
"state": "OR",
"postal_code": "978141340",
"telephone_number": "541-523-7400",
"fax_number": "541-523-4927"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3425 13TH ST",
"city": "BAKER CITY",
"state": "OR",
"postal_code": "978141340",
"telephone_number": "541-523-7400",
"fax_number": "541-523-4927"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOERMA",
"first_name": "BRIAN",
"middle_name": "JAMES",
"name_prefix": "Mr.",
"credential": "M.A",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-06-26",
"last_updated": "2022-07-29",
"certification_date": "2022-07-29",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MI",
"license": "6401010452",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "OR",
"license": "C5728",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "500794921",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ODL",
"identifier": "B176375",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Baker City, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.