NPIMap

Organization Active NPI

Columbiacare Services

  • Psychiatric Residential Treatment Facility
  • Portland, OR
National Provider Identifier
1386720142
Registry record updated May 13, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Residential Treatment FacilityTaxonomy code 323P00000X
License
801 Issued in OR
Legal business name
COLUMBIACARE SERVICES
Practice address
12505 SE Raymond St
Portland, OR 97236-3931
Phone
(503) 760-8300
Fax
(503) 760-8308
NPI assigned
Oct 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2009

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

Authorized official

Name
Mr. Robert C Beckett
Title
Executive Director
Phone
(541) 858-8170

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X 801 OR
Psychiatric Residential Treatment Facility 323P00000X 801 OR Primary

Addresses

Primary practice location

12505 SE Raymond St
Portland, OR 97236-3931

Mailing address

3587 Heathrow Way
Medford, OR 97504
Phone (541) 858-8170

Other identifiers 2

IdentifierTypeStateIssuer
516052OtherORW ROSE SERVICE PMT
241906MedicaidOR

Other names 1

  • Willamette Rose Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170420001277 OR Part B Supplier - Clinic/Group Practice 6901182229 Receives reassigned benefits from 15 practitioners
32 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Medford, OR

Other NPIs on the same Medicare enrollment 32

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 32

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 63

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 63

NPI Registry JSON

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

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1242172800000",
    "number": "1386720142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3587 HEATHROW WAY",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "97504",
            "telephone_number": "541-858-8170",
            "fax_number": "541-858-8167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12505 SE RAYMOND ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972363931",
            "telephone_number": "503-760-8300",
            "fax_number": "503-760-8308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLUMBIACARE SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-27",
        "last_updated": "2009-05-13",
        "status": "A",
        "authorized_official_last_name": "BECKETT",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "541-858-8170",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "OR",
            "license": "801",
            "primary": false
        },
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": "OR",
            "license": "801",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "W ROSE SERVICE PMT",
            "identifier": "516052",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "241906",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Willamette Rose",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 May 13, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.