Active NPI
Benjamin Adam Nielsen, DMD
- Endodontics
- Portland, OR
National Provider Identifier
1538183348
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- D8379
- Practice address
- 700 NE Multnomah St
Suite 880
Portland, OR 97232-2131 - Phone
- (503) 230-1234
- Fax
- (503) 239-7741
- NPI assigned
- Jul 26, 2006
- 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 |
|---|---|---|---|---|
| Endodontics | 1223E0200X | D8379 | OR | Primary |
Addresses
Primary practice location
700 NE Multnomah St
Suite 880
Portland, OR 97232-2131
Mailing address
14938 SE Stanhope Rd
Clackamas, OR 97015-5413
Phone (503) 558-8428
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260218003963 | OR | Order and Referring Only - Endodontics | 4587144480 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D8379 | OR | MD | Endodontist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Endodontic Associates, P.C. | Endodontics | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Endodontics
- Portland, OR
- NPI 1356348379
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153872000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1538183348",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14938 SE STANHOPE RD",
"city": "CLACKAMAS",
"state": "OR",
"postal_code": "970155413",
"telephone_number": "503-558-8428"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "700 NE MULTNOMAH ST",
"address_2": "SUITE 880",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972322131",
"telephone_number": "503-230-1234",
"fax_number": "503-239-7741"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NIELSEN",
"first_name": "BENJAMIN",
"middle_name": "ADAM",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "OR",
"license": "D8379",
"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 Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.