NPIMap

Organization Active NPI

Columbiacare Services

  • Mental Illness Community Based Residential Treatment Facility
  • Portland, OR
National Provider Identifier
1700273638
Registry record updated Apr 17, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
Legal business name
COLUMBIACARE SERVICES
Practice address
17700 NE Halsey St
Portland, OR 97230-6734
Phone
(541) 858-8170
Fax
(541) 858-8167
NPI assigned
Apr 17, 2015
Last updated
Apr 17, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2015

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

Authorized official

Name
Mike David Sewitsky
Title
Finance Manager
Phone
(541) 858-8170

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X NU Primary

Addresses

Primary practice location

17700 NE Halsey St
Portland, OR 97230-6734

Mailing address

3587 Heathrow Way
Medford, OR 97504
Phone (541) 858-8170

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170420001277 OR Part B Supplier - Clinic/Group Practice 6901182229 Receives reassigned benefits from 15 practitioners
32 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Medford, OR

Other NPIs on the same Medicare enrollment 32

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 32

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1429228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1429228800000",
    "number": "1700273638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3587 HEATHROW WAY",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "97504",
            "telephone_number": "541-858-8170",
            "fax_number": "541-858-8167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17700 NE HALSEY ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972306734",
            "telephone_number": "541-858-8170",
            "fax_number": "541-858-8167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLUMBIACARE SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-17",
        "last_updated": "2015-04-17",
        "status": "A",
        "authorized_official_last_name": "SEWITSKY",
        "authorized_official_first_name": "MIKE",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "FINANCE MANAGER",
        "authorized_official_telephone_number": "541-858-8170"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "NU",
            "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 Apr 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.