Jacob Benjamin Johnston

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

License

THW000002220 Issued in OR

Practice address

1233 Edgewater St NW
Salem, OR 97304-4049

Phone

(503) 378-7526

Fax

(503) 480-1611

NPI assigned

Oct 15, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1571097600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595462400000",
    "number": "1407498074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1525 PLAZA ST NW",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973044614",
            "telephone_number": "503-877-8567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1233 EDGEWATER ST NW",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973044049",
            "telephone_number": "503-378-7526",
            "fax_number": "503-480-1611"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6200 Poplar Ln",
            "address_purpose": "LOCATION",
            "city": "Independence",
            "state": "OR",
            "postal_code": "973519659",
            "country_code": "US",
            "telephone_number": "503-877-8567",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSTON",
        "first_name": "JACOB",
        "middle_name": "BENJAMIN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-10-15",
        "last_updated": "2020-07-23",
        "certification_date": "2020-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "3747A0650X",
            "taxonomy_group": "",
            "desc": "Technician, Attendant Care Provider",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "OR",
            "license": "THW000002220",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tyrque Allen Johnson
• Valerie Johnson, CRM
• Valerie Christine Johnson, CSWA
• Amanda Rae Johnston, D.O.
• Cassidy Johnston, DO
• Mikala Rae Johnston
• Paul Allen Johnston, THW
• Tracy B Jolivette, LMT
• Karen Bolinger Jones Shorr, ND
• Leanna Jones-Bishop, LPC

• Community Health Worker in Salem, OR
• Providers in Salem, OR by specialty
• Community Health Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.