NPIMap

Individual provider Active NPI

Derek Lee Ward

  • Addiction (Substance Use Disorder) Counselor
  • Portland, OR
National Provider Identifier
1659918886
Registry record updated Aug 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
Practice address
1030 NE Couch St
Portland, OR 97232-3067
Phone
(503) 239-8400
Fax
(503) 239-8406
NPI assigned
Dec 6, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Companion 372600000X
Addiction (Substance Use Disorder) Counselor 101YA0400X Primary

Addresses

Primary practice location

1030 NE Couch St
Portland, OR 97232-3067

Mailing address

1027 E Burnside St
Portland, OR 97214-1328
Phone (503) 239-8400

Other practice location 1

847 NE 19th Ave Ste 100
Portland, OR 97232-2684
Phone (503) 238-0769

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

Practice roles

OrganizationSpecialtyStatusNew patients
Coda, Inc. Addiction (Substance Use Disorder) CurrentSince Aug 28, 2021 Accepting new patients
Coda, Inc. CurrentSince Aug 28, 2021 Accepting new patients
University Professional Services PastSince Aug 28, 2021 Accepting new patients
University Professional Services PastSince Aug 28, 2021 Accepting new patients

Locations

1027 E Burnside St
Portland, OR 97214

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1575590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629158400000",
    "number": "1659918886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1027 E BURNSIDE ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972141328",
            "telephone_number": "503-239-8400",
            "fax_number": "503-239-8407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1030 NE COUCH ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972323067",
            "telephone_number": "503-239-8400",
            "fax_number": "503-239-8406"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "847 NE 19th Ave Ste 100",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972322684",
            "country_code": "US",
            "telephone_number": "503-238-0769",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WARD",
        "first_name": "DEREK",
        "middle_name": "LEE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-12-06",
        "last_updated": "2021-08-17",
        "certification_date": "2021-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "372600000X",
            "taxonomy_group": "",
            "desc": "Adult Companion",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "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 Aug 17, 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.

Verify at the official NPI Registry.