Individual provider Active NPI

Erin R Medeiros, RN/QMHP-R

  • Registered Nurse
  • Portland, OR
National Provider Identifier
1639553563
Registry record updated Apr 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
201507345RN Issued in OR
Practice address
703 NE Hancock St
Portland, OR 97212-3955
Phone
(503) 230-9875
Fax
(503) 331-3441
NPI assigned
Jul 9, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 24-QMHP-R-2536 OR
Registered Nurse 163W00000X RN60589243 WA
Registered Nurse 163W00000X 201507345RN OR Primary

Addresses

Primary practice location

703 NE Hancock St
Portland, OR 97212-3955

Mailing address

211 SE Caruthers St
Portland, OR 97214-4502
Phone (503) 224-1044

Other practice location 1

12360 E Burnside St
Portland, OR 97233-1042
Phone (971) 279-4800

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
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
24-QMHP-R-2536ORMDMental Health Counselor
201507345RNORMDRegistered Nurse
RN60589243WAMDRegistered Nurse

NPI Registry JSON

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

{
    "created_epoch": "1436400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744848000000",
    "number": "1639553563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 SE CARUTHERS ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972144502",
            "telephone_number": "503-224-1044",
            "fax_number": "971-260-0355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "703 NE HANCOCK ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972123955",
            "telephone_number": "503-230-9875",
            "fax_number": "503-331-3441"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12360 E Burnside St",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972331042",
            "country_code": "US",
            "telephone_number": "971-279-4800",
            "fax_number": "971-279-2051",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MEDEIROS",
        "first_name": "ERIN",
        "middle_name": "R",
        "name_prefix": "Ms.",
        "credential": "RN/QMHP-R",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-09",
        "last_updated": "2025-04-17",
        "certification_date": "2025-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": "24-QMHP-R-2536",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WA",
            "license": "RN60589243",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OR",
            "license": "201507345RN",
            "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 Apr 17, 2025; 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.