Active NPI
Trystan Rose
- Mental Health Counselor
- Portland, OR
National Provider Identifier
1558801019
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 5100 SW Macadam Ave
# 400
Portland, OR 97239-6102 - Phone
- (503) 244-5211
- NPI assigned
- Mar 3, 2017
- Sex
- Female
- 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 | Primary |
Addresses
Primary practice location
5100 SW Macadam Ave
# 400
Portland, OR 97239-6102
Mailing address
5100 SW Macadam Ave
# 400
Portland, OR 97239-6102
Phone (503) 244-5211
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: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 2021
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
PO Box
Dallas, TX 75373
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sondermind, P.a. | Mental Health | Current | Accepting new patients |
| Lines for Life | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Community/Behavioral Health Agency
- Portland, OR
- NPI 1891246070
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1488499200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1488499200000",
"number": "1558801019",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5100 SW MACADAM AVE",
"address_2": "# 400",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972396102",
"telephone_number": "503-244-5211"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5100 SW MACADAM AVE",
"address_2": "# 400",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972396102",
"telephone_number": "503-244-5211"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROSE",
"first_name": "TRYSTAN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-03-03",
"last_updated": "2017-03-03",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"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 Mar 3, 2017; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.