Bradley Charles Viles, CRM/ CADC1-R/ QMHA-R

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

License

18-CRM-366 Issued in OR

Practice address

58646 McNulty Way
Saint Helens, OR 97051-6210

Phone

(503) 397-5211

NPI assigned

Jun 17, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Bradley Charles Balcuns Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Medicine Wheel Recovery Services, Inc.

  • Community/Behavioral Health Agency
  • Saint Helens, OR
  • NPI 1730553876
  NPD (past)

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

{
    "created_epoch": "1560729600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665619200000",
    "number": "1346800976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1234",
            "city": "SAINT HELENS",
            "state": "OR",
            "postal_code": "970518234",
            "telephone_number": "503-432-9259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "58646 MCNULTY WAY",
            "city": "SAINT HELENS",
            "state": "OR",
            "postal_code": "970516210",
            "telephone_number": "503-397-5211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VILES",
        "first_name": "BRADLEY",
        "middle_name": "CHARLES",
        "credential": "CRM/ CADC1-R/ QMHA-R",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-17",
        "last_updated": "2022-10-13",
        "certification_date": "2022-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "OR",
            "license": "18-CRM-366",
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CRM CERTIFICATION",
            "identifier": "18-CRM-366",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BRADLEY",
            "last_name": "BALCUNS",
            "middle_name": "CHARLES",
            "credential": "CRM/ CADC-R/ QMHA-R",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Natallie Joy Vandyke, BA
• Samantha Lee Vanlaer, QMHA
• Linda A Vanlear, QMHP
• Jonathan Ray Vanzandt
• Magdalene Kidd Vasconez
• Scott Wachter, M.A., QMHP
• Amanda Wagner
• Ashly Ann Wagner, CADC-R
• Shannon Dee Wagner
• Norma L Wahl

• All providers in Saint Helens, OR
• Peer Specialist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2022; 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.