Individual provider Active NPI

Amy Busiek

  • Clinical Social Worker
  • Portland, OR
National Provider Identifier
1558819094
Registry record updated Dec 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Practice address
4212 SE Division St Ste 100
Portland, OR 97206-1680
Phone
(503) 238-0705
NPI assigned
Sep 13, 2016
Last updated
Dec 1, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
Clinical Social Worker 1041C0700X Primary

Addresses

Primary practice location

4212 SE Division St Ste 100
Portland, OR 97206-1680

Mailing address

PO Box 8459
Portland, OR 97207-8459

Other practice location 1

847 NE 19th Ave Ste 100
Portland, OR 97232-2684
Phone (503) 238-0769

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230602002615 OR Practitioner - Clinical Social Worker 5698132819 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Cascadia Health CurrentSince Feb 16, 2023 Accepting new patients
Cascadia Health CurrentSince Feb 16, 2023 Accepting new patients

Locations

3036 NE Mlk Jr Blvd
Portland, OR 97212
Phone (503) 283-3763

4212 SE Division St
Ste 100
Portland, OR 97206
Phone (503) 238-0705

707 NW Everett St
Portland, OR 97209
Phone (503) 222-4906

847 NE 19th Ave
Ste 100
Portland, OR 97232
Phone (503) 552-6203

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1473724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606780800000",
    "number": "1558819094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8459",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972078459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4212 SE DIVISION ST STE 100",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972061680",
            "telephone_number": "503-238-0705"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "847 NE 19th Ave Ste 100",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972322684",
            "country_code": "US",
            "telephone_number": "503-238-0769",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BUSIEK",
        "first_name": "AMY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-13",
        "last_updated": "2020-12-01",
        "certification_date": "2020-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.