Kevin Dale Bodin, QMHA, C.A.D.C. I

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

License

93-6002307 Issued in OR

Practice address

3180 Center St NE Ste 2100
Salem, OR 97301-4592

Phone

(503) 585-4949

NPI assigned

May 24, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1306195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651968000000",
    "number": "1659664696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3180 CENTER ST NE STE 2100",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973014592",
            "telephone_number": "503-585-4949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3180 CENTER ST NE STE 2100",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973014592",
            "telephone_number": "503-585-4949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BODIN",
        "first_name": "KEVIN",
        "middle_name": "DALE",
        "name_prefix": "Mr.",
        "credential": "QMHA, C.A.D.C. I",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-05-24",
        "last_updated": "2022-05-08",
        "certification_date": "2022-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "OR",
            "license": "93-6002307",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "122994",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jordan Bobb, RDH, EPDH
• Emily C Bobbitt, LMT
• Julie Bochsler
• Summer Sunshine Bock, LMT
• Nathan K. Boddie, M.D., M.S.
• Trevor Bodine, PTA
• Peter Bodmer
• Ekaterina Bodunov
• Victoria Boechler, PT, DPT
• Timothy John Boehm, DMD

• All providers in Salem, OR
• Case Manager/Care Coordinator in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 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.