Active NPI
Wilford Johnson, PSS, CRM
- Peer Specialist
- Portland, OR
National Provider Identifier
1538789656
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- License
- THW000004160
- Practice address
- 3311 NE Martin Luther King Jr Blvd Ste 104
Portland, OR 97212-2086 - Phone
- (503) 206-8856
- NPI assigned
- Apr 18, 2020
- 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 |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | THW000004160 | OR | Primary |
Addresses
Primary practice location
3311 NE Martin Luther King Jr Blvd Ste 104
Portland, OR 97212-2086
Mailing address
3311 NE Martin Luther King Jr Blvd Ste 104
Portland, OR 97212-2086
Phone (503) 206-8856
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| THW000004160 | Other | OR | OREGON HEALTH AUTHORITY |
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 |
|---|---|---|---|
| THW000004160 | OR | MD | Peer Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1587168000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1587168000000",
"number": "1538789656",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3311 NE MARTIN LUTHER KING JR BLVD STE 104",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972122086",
"telephone_number": "503-206-8856"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3311 NE MARTIN LUTHER KING JR BLVD STE 104",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972122086",
"telephone_number": "503-206-8856"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "WILFORD",
"credential": "PSS, CRM",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-04-18",
"last_updated": "2020-04-18",
"certification_date": "2020-04-18",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "OR",
"license": "THW000004160",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OREGON HEALTH AUTHORITY",
"identifier": "THW000004160",
"state": "OR"
}
],
"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 Apr 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.