Active NPI
Jack Lemuel Davidson
- Social Worker
- Portland, OR
National Provider Identifier
1245663608
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- Practice address
- 707 NE Couch St
Portland, OR 97232-2922 - Phone
- (503) 542-4603
- Fax
- (503) 233-6093
- NPI assigned
- Aug 20, 2013
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | Primary |
Addresses
Primary practice location
707 NE Couch St
Portland, OR 97232-2922
Mailing address
3710 N Arlington PL
Portland, OR 97217-7212
Phone (503) 432-3975
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 |
|---|---|---|---|
| Janus Youth Programs | Past | Accepting new patients | |
| Janus Youth Programs, Inc. | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Substance Abuse Rehabilitation Facility
- Portland, OR
- NPI 1912331646
-
- Voluntary or Charitable Agency
- Portland, OR
- NPI 1003248642
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1376956800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1377043200000",
"number": "1245663608",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3710 N ARLINGTON PL",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972177212",
"telephone_number": "503-432-3975",
"fax_number": "503-467-0582"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "707 NE COUCH ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972322922",
"telephone_number": "503-542-4603",
"fax_number": "503-233-6093"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIDSON",
"first_name": "JACK",
"middle_name": "LEMUEL",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-08-20",
"last_updated": "2013-08-21",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": null,
"license": null,
"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 Aug 21, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.