Stephen Ross Canova

Primary specialty

CounselorTaxonomy code 101Y00000X

Practice address

5100 SW Macadam Ave
Suite 400
Portland, OR 97239-6102

Phone

(503) 244-5211

NPI assigned

Oct 30, 2015

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• Lines for Life

  • Community/Behavioral Health Agency
  • Portland, OR
  • NPI 1891246070
  NPD (past)

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

{
    "created_epoch": "1446163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1446163200000",
    "number": "1679945562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5125 NE DAVIS ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972133026",
            "telephone_number": "480-586-1333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5100 SW MACADAM AVE",
            "address_2": "SUITE 400",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972396102",
            "telephone_number": "503-244-5211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANOVA",
        "first_name": "STEPHEN",
        "middle_name": "ROSS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-10-30",
        "last_updated": "2015-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Keli Mikal Cannon
• Jackie Elise Cano, MA
• Marissa Cano
• Canopy Clinic PDX LLC
• Dylan Hay Canova
• Marian Cansdale, SLP
• Carla Y Canseco-Maca
• Johnni Jo Cansler, APRN
• Amanda Cantal, MA, LPC, CADC I
• Canter Naturopathic, LLC

• All providers in Portland, OR
• Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2015; 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.