Active NPI
Kenneth Clifton Patterson, THW000104598
- Peer Specialist
- Salem, OR
National Provider Identifier
1568034742
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- License
- THW000104598
- Practice address
- 2555 Silverton Rd NE
Salem, OR 97301-0837 - Phone
- (503) 573-7018
- NPI assigned
- Jul 15, 2021
- Sex
- Male
- Sole proprietor
- Yes
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 | THW000104598 | OR | Primary |
Addresses
Primary practice location
2555 Silverton Rd NE
Salem, OR 97301-0837
Mailing address
2555 Silverton Rd NE
Salem, OR 97301-0837
Phone (503) 573-7018
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| THW000105498 | Other | OR | OHA OFFICE OF EQUITY AND INCLUSION TRADITIONAL HEALTH WORKER |
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 |
|---|---|---|---|
| THW000104598 | OR | MD | Peer Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1626307200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1626307200000",
"number": "1568034742",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2555 SILVERTON RD NE",
"city": "SALEM",
"state": "OR",
"postal_code": "973010837",
"telephone_number": "503-573-7018"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2555 SILVERTON RD NE",
"city": "SALEM",
"state": "OR",
"postal_code": "973010837",
"telephone_number": "503-573-7018"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PATTERSON",
"first_name": "KENNETH",
"middle_name": "CLIFTON",
"credential": "THW000104598",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-07-15",
"last_updated": "2021-07-15",
"certification_date": "2021-07-15",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "OR",
"license": "THW000104598",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OHA OFFICE OF EQUITY AND INCLUSION TRADITIONAL HEALTH WORKER",
"identifier": "THW000105498",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Salem, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.