Active NPI
Ethan J Newcomb, PSS
- Peer Specialist
- Portland, OR
National Provider Identifier
1699373324
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- License
- THW000104645
- Practice address
- 1438 SE Division St
Portland, OR 97202-1140 - Phone
- (503) 548-0346
- Fax
- (503) 232-5959
- NPI assigned
- Oct 14, 2020
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | THW000104645 | OR | Primary |
Addresses
Primary practice location
1438 SE Division St
Portland, OR 97202-1140
Mailing address
1776 SW Madison St
Portland, OR 97205-1715
Phone (503) 224-1044
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 500795004 | Medicaid | OR |
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 |
|---|---|---|---|
| THW000104645 | OR | MD | Peer Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1602633600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1629936000000",
"number": "1699373324",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1776 SW MADISON ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972051715",
"telephone_number": "503-224-1044",
"fax_number": "503-621-2235"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1438 SE DIVISION ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972021140",
"telephone_number": "503-548-0346",
"fax_number": "503-232-5959"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NEWCOMB",
"first_name": "ETHAN",
"middle_name": "J",
"credential": "PSS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-10-14",
"last_updated": "2021-08-26",
"certification_date": "2021-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "OR",
"license": "THW000104645",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "500795004",
"state": "OR"
}
],
"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 26, 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.