Active NPI
Raymond Andrew Jim Jr., NACADC
- Addiction (Substance Use Disorder) Counselor
- Owyhee, NV
National Provider Identifier
1497092407
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 00105-C
- Practice address
- 1623 Hospital Loop
Owyhee, NV 89832-0130 - Phone
- (775) 757-2415
- Fax
- (775) 757-3010
- NPI assigned
- Jan 10, 2013
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 00105-C | NV | Primary |
Addresses
Primary practice location
1623 Hospital Loop
Owyhee, NV 89832-0130
Mailing address
PO Box 130
Owyhee, NV 89832-0130
Phone (775) 757-2415
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 |
|---|---|---|---|
| 00105-C | NV | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1357776000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1357776000000",
"number": "1497092407",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 130",
"city": "OWYHEE",
"state": "NV",
"postal_code": "898320130",
"telephone_number": "775-757-2415",
"fax_number": "775-757-3010"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1623 HOSPITAL LOOP",
"city": "OWYHEE",
"state": "NV",
"postal_code": "898320130",
"telephone_number": "775-757-2415",
"fax_number": "775-757-3010"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JIM",
"first_name": "RAYMOND",
"middle_name": "ANDREW",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"credential": "NACADC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-01-10",
"last_updated": "2013-01-10",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "NV",
"license": "00105-C",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Owyhee, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.