Active NPI
Brandon Joseph Fulps, CRM
- Peer Specialist
- Portland, OR
National Provider Identifier
1346088986
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- License
- 24CRM3393
- Practice address
- 6828 SE Holgate Blvd
Portland, OR 97206-3504 - Phone
- (971) 803-8290
- NPI assigned
- Jul 17, 2024
- 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 |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | 24CRM3393 | OR | Primary |
Addresses
Primary practice location
6828 SE Holgate Blvd
Portland, OR 97206-3504
Mailing address
3181 NE 23Rd St Apt F127
Gresham, OR 97030-4316
Phone (971) 381-7561
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 |
|---|---|---|---|
| 24CRM3393 | OR | MD | Peer Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1721174400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1721174400000",
"number": "1346088986",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3181 NE 23RD ST APT F127",
"city": "GRESHAM",
"state": "OR",
"postal_code": "970304316",
"telephone_number": "971-381-7561"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6828 SE HOLGATE BLVD",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972063504",
"telephone_number": "971-803-8290"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FULPS",
"first_name": "BRANDON",
"middle_name": "JOSEPH",
"credential": "CRM",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-07-17",
"last_updated": "2024-07-17",
"certification_date": "2024-07-16",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "OR",
"license": "24CRM3393",
"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 Jul 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.