NPIMap

Organization Active NPI

Pivot Behavioral Health LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Bend, OR
National Provider Identifier
1447926829
Registry record updated Sep 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
PIVOT BEHAVIORAL HEALTH LLC
Practice address
1001 SW Disk Dr Ste 250
Bend, OR 97702-3754
Phone
(541) 293-1325
Fax
(541) 229-1314
NPI assigned
Aug 17, 2021
Last updated
Sep 23, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2024

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

Authorized official

Name
Brea Di Dato, PMHNPNPI 1770025959
Title
Owner
Phone
(541) 293-1325

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X Primary

Addresses

Primary practice location

1001 SW Disk Dr Ste 250
Bend, OR 97702-3754

Mailing address

1001 SW Disk Dr Ste 250
Bend, OR 97702-3754
Phone (541) 293-1325

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220219000023 OR Part B Supplier - Clinic/Group Practice 7012301989 Receives reassigned benefits from 2 practitioners
Practice locations: Bend, OR

National Provider Directory

National Provider Directory

Locations

7412 SW Beaverton Hillsdale Hwy
Ste 106
Portland, OR 97225
Phone (503) 530-8521

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1629158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727049600000",
    "number": "1447926829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 SW DISK DR STE 250",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977023754",
            "telephone_number": "541-293-1325",
            "fax_number": "541-229-1314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 SW DISK DR STE 250",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977023754",
            "telephone_number": "541-293-1325",
            "fax_number": "541-229-1314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PIVOT BEHAVIORAL HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-17",
        "last_updated": "2024-09-23",
        "certification_date": "2024-09-23",
        "status": "A",
        "authorized_official_last_name": "DI DATO",
        "authorized_official_first_name": "BREA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "541-293-1325",
        "authorized_official_credential": "PMHNP"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bend, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2024; 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.