Northstar Iop LLC

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

Legal business name

NORTHSTAR IOP LLC

Practice address

16100 NW Cornell Rd Ste 220B
Beaverton, OR 97006-7334

Phone

(503) 878-8885

NPI assigned

Dec 9, 2022

Organization subpart

No

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

Authorized official

Name

Ms. Ryan Glock

Title

Partner

Phone

(503) 888-8050

Specialties & licenses 1

Addresses

Electronic endpoints 1

Locations

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

{
    "created_epoch": "1670544000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670544000000",
    "number": "1609587708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16100 NW CORNELL RD STE 220B",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970067334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16100 NW CORNELL RD STE 220B",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970067334",
            "telephone_number": "503-878-8885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHSTAR IOP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-09",
        "last_updated": "2022-12-09",
        "certification_date": "2022-12-08",
        "status": "A",
        "authorized_official_last_name": "GLOCK",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "503-888-8050",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "EMR",
            "affiliation": "N",
            "address_1": "16100 NW Cornell Rd Ste 220B",
            "city": "Beaverton",
            "state": "OR",
            "country_code": "US",
            "postal_code": "970067334",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Substance Use Disorder Rehabilitation Clinic/Center in Beaverton, OR
• Providers in Beaverton, OR by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.