Active NPI
Justin William Bush, PH.D.
- Psychologist
- Portland, OR
National Provider Identifier
1356645956
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 2154
- Practice address
- 2100 NE Broadway
Suite 101
Portland, OR 97232-1569 - Phone
- (503) 287-2800
- NPI assigned
- Dec 22, 2010
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 2154 | OR | Primary |
Addresses
Primary practice location
2100 NE Broadway
Suite 101
Portland, OR 97232-1569
Mailing address
2100 NE Broadway
Suite 101
Portland, OR 97232-1569
Phone (503) 287-2800
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2154 | OR | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1292976000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1298678400000",
"number": "1356645956",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2100 NE BROADWAY",
"address_2": "SUITE 101",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972321569",
"telephone_number": "503-287-2800"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2100 NE BROADWAY",
"address_2": "SUITE 101",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972321569",
"telephone_number": "503-287-2800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUSH",
"first_name": "JUSTIN",
"middle_name": "WILLIAM",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-12-22",
"last_updated": "2011-02-26",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "OR",
"license": "2154",
"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 Feb 26, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.