Michele Tantriella-Modell, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

C1796 Issued in OR

Practice address

66 Club Rd Ste 160
Eugene, OR 97401-2439

Phone

(541) 345-1722

Fax

(541) 485-7049

NPI assigned

Oct 17, 2011

Sex

Female

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 2

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

Specialty

Mental Health Counselor

Education

Other, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Amber Benson Pmhnp PCGroup PAC ID 3072786755, 24 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Amber Benson Pmhnp PC

  • Psychiatric/Mental Health Nurse Practitioner
  • Eugene, OR
  • NPI 1912042862
  Medicare reassignment Care Compare group NPD
• Addiction Counseling and Education Services Inc.

  • Mental Health Counselor
  • Eugene, OR
  • NPI 1780712851
  NPD (past)

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

{
    "created_epoch": "1318809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699920000000",
    "number": "1376828772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 70779",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "974750137",
            "telephone_number": "541-345-1722",
            "fax_number": "541-485-7049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "66 CLUB RD STE 160",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974012439",
            "telephone_number": "541-345-1722",
            "fax_number": "541-485-7049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TANTRIELLA-MODELL",
        "first_name": "MICHELE",
        "name_prefix": "Ms.",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-10-17",
        "last_updated": "2023-11-14",
        "certification_date": "2023-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": "C1796",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OR",
            "license": "C1796",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500641977",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH ID",
            "identifier": "14652890",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Patrick Galvan Tandingan, M.D.
• Sharon Tang, PH.D.
• Jordan Tangavelou
• Elizabeth Tanner, FNP
• Joel Tanner
• Monica S Tapia
• Angeni A Tapscott, RN
• Lisa Ann Tardie
• Tanya Tarusan, HIS
• Jennifer Tarver

• Professional Counselor in Eugene, OR
• Providers in Eugene, OR by specialty
• Professional Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2023; 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.

Verify at the official NPI Registry.