Individual provider Active NPI

Amber Miller, LCSW

  • Clinical Social Worker
  • Portland, OR
National Provider Identifier
1356734750
Registry record updated Aug 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
L8015 Issued in OR
Practice address
3415 SE Powell Blvd
Portland, OR 97202-3371
Phone
(712) 353-1519
NPI assigned
Mar 9, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X L8015 OR Primary

Addresses

Primary practice location

3415 SE Powell Blvd
Portland, OR 97202-3371

Mailing address

811 NW 19TH Ave
Portland, OR 97209-1401
Phone (541) 286-5002

Other identifiers 1

IdentifierTypeStateIssuer
500702590MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240827004224 OR Practitioner - Clinical Social Worker 8628517232 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Conifer Wellness IncGroup PAC ID 3971916537, 3 clinicians

Practice addresses (Care Compare)

139 SW 3Rd St
Corvallis, OR 97333-4713
Phone (541) 908-1095

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
L8015ORMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Conifer Wellness, Inc. CurrentSince Aug 26, 2024 Accepting new patients

Locations

139 SW 3rd St
Corvallis, OR 97333
Phone (248) 303-3751

811 NW 19th Ave
Portland, OR 97209
Phone (541) 286-5002

811 NW 19th Ave
Ste 204
Portland, OR 97209

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1425859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724630400000",
    "number": "1356734750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "811 NW 19TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972091401",
            "telephone_number": "541-286-5002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3415 SE POWELL BLVD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972023371",
            "telephone_number": "712-353-1519"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "AMBER",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-03-09",
        "last_updated": "2024-08-26",
        "certification_date": "2024-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L8015",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500702590",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.