Marissa Marie Baumgartner, THW – Peer Specialist

Key facts

NPI: 1447720529
Entity type: Individual (NPI type 1)
Primary specialty: Peer Specialist 175T00000X
License: THW000003147 (OR)
Practice address: 46314 Timine Way
Pendleton, OR 97801-9417
Phone: (541) 966-9830
Fax: (541) 278-7572
NPI assigned: Nov 30, 2018
Sex: Female
Sole proprietor: No

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
THW000003147	OR	MD	Peer Specialist

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Peer Specialist	175T00000X	THW000003147	OR	Yes

Addresses

Primary practice location

46314 Timine Way
Pendleton, OR 97801-9417

Mailing address

46314 Timine Way
Pendleton, OR 97801-9417
Phone (541) 966-9830

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Nov 30, 2018.

{
    "created_epoch": "1543536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543536000000",
    "number": "1447720529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "46314 TIMINE WAY",
            "city": "PENDLETON",
            "state": "OR",
            "postal_code": "978019417",
            "telephone_number": "541-966-9830",
            "fax_number": "541-278-7572"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "46314 TIMINE WAY",
            "city": "PENDLETON",
            "state": "OR",
            "postal_code": "978019417",
            "telephone_number": "541-966-9830",
            "fax_number": "541-278-7572"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAUMGARTNER",
        "first_name": "MARISSA",
        "middle_name": "MARIE",
        "credential": "THW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-11-30",
        "last_updated": "2018-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "OR",
            "license": "THW000003147",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pendleton, OR

All providers in Pendleton, OR · Peer Specialist in Oregon

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 30, 2018. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.