Active NPI
Mario Alfonso Cardenas
- Addiction (Substance Use Disorder) Counselor
- Portland, OR
National Provider Identifier
1427417500
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- Practice address
- 10570 SE Washington St
Portland, OR 97216-2846 - Phone
- (503) 995-3736
- NPI assigned
- Feb 17, 2016
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | 12-CRM-074 | OR | |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | Primary |
Addresses
Primary practice location
10570 SE Washington St
Portland, OR 97216-2846
Mailing address
2336 NE Francis PL
Gresham, OR 97030-3210
Phone (503) 995-3736
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 12-CRM-074 | 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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12-CRM-074 | OR | MD | Peer Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1455667200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1427417500",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2336 NE FRANCIS PL",
"city": "GRESHAM",
"state": "OR",
"postal_code": "970303210",
"telephone_number": "503-995-3736"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10570 SE WASHINGTON ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972162846",
"telephone_number": "503-995-3736"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARDENAS",
"first_name": "MARIO",
"middle_name": "ALFONSO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-02-17",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "OR",
"license": "12-CRM-074",
"primary": false
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "12-CRM-074",
"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 Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.