Active NPI
John Shade
- Acupuncturist
- Portland, OR
National Provider Identifier
1558855312
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acupuncturist
- License
- AC186199
- Practice address
- 914 SW 11TH Ave
Portland, OR 97205-2001 - Phone
- (503) 427-9358
- NPI assigned
- Jun 15, 2018
- 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 |
|---|---|---|---|---|
| Acupuncturist | 171100000X | AC186199 | OR | Primary |
Addresses
Primary practice location
914 SW 11TH Ave
Portland, OR 97205-2001
Mailing address
2904 SE Belmont St Apt 17
Portland, OR 97214-4049
Phone (818) 934-6062
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 |
|---|---|---|---|
| AC186199 | OR | MD | Acupuncturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1529020800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1529020800000",
"number": "1558855312",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2904 SE BELMONT ST APT 17",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972144049",
"telephone_number": "818-934-6062"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "914 SW 11TH AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972052001",
"telephone_number": "503-427-9358"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHADE",
"first_name": "JOHN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-06-15",
"last_updated": "2018-06-15",
"status": "A"
},
"taxonomies": [
{
"code": "171100000X",
"taxonomy_group": "",
"desc": "Acupuncturist",
"state": "OR",
"license": "AC186199",
"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 15, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.