Individual provider Active NPI

Micheal Draheim, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Beaverton, OR
National Provider Identifier
1669153706
Registry record updated Jul 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
10013325 Issued in OR
Practice address
12325 SW 174TH Ter
Beaverton, OR 97007-2064
Phone
(503) 915-6858
NPI assigned
Jul 31, 2023
Last updated
Jul 31, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 10013325 OR Primary

Addresses

Primary practice location

12325 SW 174TH Ter
Beaverton, OR 97007-2064

Mailing address

12325 SW 174TH Ter
Beaverton, OR 97007-2064
Phone (503) 915-6858

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240208001476 OR Practitioner - Nurse Practitioner 7911340765 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Robert Olsen MD Washington PC CurrentSince Oct 6, 2024 Accepting new patients
Robert Olsen MD LLC CurrentSince Dec 25, 2023 Accepting new patients

Locations

9895 SE Sunnyside Rd
Ste F
Clackamas, OR 97015

13535 SW 72nd Ave
Ste 170
Portland, OR 97223
Phone (303) 468-8018

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1690761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690761600000",
    "number": "1669153706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12325 SW 174TH TER",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970072064",
            "telephone_number": "503-915-6858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12325 SW 174TH TER",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970072064",
            "telephone_number": "503-915-6858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DRAHEIM",
        "first_name": "MICHEAL",
        "credential": "PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-07-31",
        "last_updated": "2023-07-31",
        "certification_date": "2023-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OR",
            "license": "10013325",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Beaverton, OR

Sources for this page

Verify at the official NPI Registry.