Active NPI
Michael Sketch, CGAC II, CGRM
- Peer Specialist
- Salem, OR
National Provider Identifier
1699338681
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- License
- 15CGRM001
- Practice address
- 3325 Harold Dr NE
Salem, OR 97305-1339 - Phone
- (503) 363-2021
- NPI assigned
- Apr 16, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | G171102 | OR | |
| Peer Specialist | 175T00000X | 15CGRM001 | OR | Primary |
Addresses
Primary practice location
3325 Harold Dr NE
Salem, OR 97305-1339
Mailing address
PO Box 17818
Salem, OR 97305-7818
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G171102 | OR | MD | Counselor |
| 15CGRM001 | OR | MD | Peer Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1555372800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1555372800000",
"number": "1699338681",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 17818",
"city": "SALEM",
"state": "OR",
"postal_code": "973057818"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3325 HAROLD DR NE",
"city": "SALEM",
"state": "OR",
"postal_code": "973051339",
"telephone_number": "503-363-2021"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SKETCH",
"first_name": "MICHAEL",
"credential": "CGAC II, CGRM",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-04-16",
"last_updated": "2019-04-16",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "OR",
"license": "G171102",
"primary": false
},
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "OR",
"license": "15CGRM001",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Salem, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.