Active NPI
Elizabeth Burdzy, QMHP-R
- Mental Health Counselor
- Portland, OR
National Provider Identifier
1376111062
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 24-QMHP-R-2549
- Practice address
- 1438 SE Division St
Portland, OR 97202-1140 - Phone
- (503) 548-0346
- Fax
- (503) 232-5959
- NPI assigned
- Jun 17, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 24-QMHP-R-2549 | OR | Primary |
| Counselor | 101Y00000X | MG61213616 | WA |
Addresses
Primary practice location
1438 SE Division St
Portland, OR 97202-1140
Mailing address
1776 SW Madison St
Portland, OR 97205-1715
Phone (503) 224-1044
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 500825220 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Marriage and Family Therapist
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
5109 NE 82ND Ave
Suite 215
Vancouver, WA 98662-6841
Phone (877) 840-6956
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MG61213616 | WA | MD | Counselor |
| 24-QMHP-R-2549 | OR | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sokyahealth Medical Group PC | Counselor | Current | Accepting new patients |
| Shashita Inamdar MD Professional Corporation | Past | Accepting new patients |
Locations
5109 NE 82nd Ave
Ste 215
Vancouver, WA 98662
Phone (832) 840-1604
Organizations & group practices 2
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.
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- San Diego, CA
- NPI 1902220809
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1623888000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1705017600000",
"number": "1376111062",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1776 SW MADISON ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972051715",
"telephone_number": "503-224-1044",
"fax_number": "503-621-2235"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1438 SE DIVISION ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972021140",
"telephone_number": "503-548-0346",
"fax_number": "503-232-5959"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURDZY",
"first_name": "ELIZABETH",
"credential": "QMHP-R",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-06-17",
"last_updated": "2024-01-12",
"certification_date": "2024-01-12",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "OR",
"license": "24-QMHP-R-2549",
"primary": true
},
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "WA",
"license": "MG61213616",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "500825220",
"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 Jan 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.