Active NPI
Mary Jean Brinkman, LAC
- Acupuncturist
- Portland, OR
National Provider Identifier
1356648349
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acupuncturist
- License
- AC153318
- Practice address
- 5308 SE Rhone St
Portland, OR 97206-2962 - Phone
- (503) 789-7661
- NPI assigned
- Feb 28, 2011
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Acupuncturist | 171100000X | AC153318 | OR | Primary |
Addresses
Primary practice location
5308 SE Rhone St
Portland, OR 97206-2962
Mailing address
5308 SE Rhone St
Portland, OR 97206-2962
Phone (503) 789-7661
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 500665880 | Medicaid | OR |
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 |
|---|---|---|---|
| AC153318 | OR | MD | Acupuncturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1298851200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1733097600000",
"number": "1356648349",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5308 SE RHONE ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972062962",
"telephone_number": "503-789-7661"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5308 SE RHONE ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972062962",
"telephone_number": "503-789-7661"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRINKMAN",
"first_name": "MARY JEAN",
"credential": "LAC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-02-28",
"last_updated": "2024-12-02",
"certification_date": "2024-12-02",
"status": "A"
},
"taxonomies": [
{
"code": "171100000X",
"taxonomy_group": "",
"desc": "Acupuncturist",
"state": "OR",
"license": "AC153318",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "500665880",
"state": "OR"
}
],
"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 Dec 2, 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.