Active NPI
Tiffany Boyum
- Social Worker
- Prineville, OR
National Provider Identifier
1417360520
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- Practice address
- 365 NE Court St
Prineville, OR 97754-1936 - Phone
- (541) 323-5330
- Fax
- (541) 447-6694
- NPI assigned
- Jun 5, 2014
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | Primary |
Addresses
Primary practice location
365 NE Court St
Prineville, OR 97754-1936
Mailing address
365 NE Court St
Prineville, OR 97754-1936
Phone (541) 323-5330
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 283234 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lutheran Community Services Northwest | Past | Accepting new patients |
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.
-
- Community/Behavioral Health Agency
- McMinnville, OR
- NPI 1255542106
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1401926400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1401926400000",
"number": "1417360520",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "365 NE COURT ST",
"city": "PRINEVILLE",
"state": "OR",
"postal_code": "977541936",
"telephone_number": "541-323-5330",
"fax_number": "541-447-6694"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "365 NE COURT ST",
"city": "PRINEVILLE",
"state": "OR",
"postal_code": "977541936",
"telephone_number": "541-323-5330",
"fax_number": "541-447-6694"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOYUM",
"first_name": "TIFFANY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-06-05",
"last_updated": "2014-06-05",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "283234",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Prineville, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.