Active NPI
Jes Ryan Bradshaw, MA
- Mental Health Counselor
- Portland, OR
National Provider Identifier
1518315829
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 2923 NE Broadway St
Portland, OR 97232-1760 - Phone
- (503) 941-0856
- NPI assigned
- May 26, 2016
- Last updated
- Jun 28, 2019
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | NU | Primary |
Addresses
Primary practice location
2923 NE Broadway St
Portland, OR 97232-1760
Mailing address
2923 NE Broadway St
Portland, OR 97232-1760
Phone (503) 941-0856
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Mar 11, 2025 through Mar 11, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1464220800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1561680000000",
"number": "1518315829",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2923 NE BROADWAY ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972321760",
"telephone_number": "503-941-0856"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2923 NE BROADWAY ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972321760",
"telephone_number": "503-941-0856"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRADSHAW",
"first_name": "JES",
"middle_name": "RYAN",
"name_prefix": "Mr.",
"credential": "MA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-05-26",
"last_updated": "2019-06-28",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"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 Jun 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.