Active NPI
Mark Anthony Halloran Jr., PSS CRM QMHAR CADCR
- Case Manager/Care Coordinator
- Portland, OR
National Provider Identifier
1710693544
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Manager/Care Coordinator
- License
- 24-QMHA-R6242
- Practice address
- 5415 SW Westgate Dr
Portland, OR 97221-2409 - Phone
- (971) 727-8026
- NPI assigned
- Jan 25, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | T-24-4760 | OR | |
| Peer Specialist | 175T00000X | 000106008 | OR | |
| Case Manager/Care Coordinator | 171M00000X | 24-QMHA-R6242 | OR | Primary |
Addresses
Primary practice location
5415 SW Westgate Dr
Portland, OR 97221-2409
Mailing address
5415 SW Westgate Dr
Portland, OR 97221-2409
Phone (971) 727-8026
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000106008 | Other | OR | TRADITIONAL HEALTH WORKER |
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 |
|---|---|---|---|
| T-24-4760 | OR | MD | Addiction (Substance Use Disorder) Counselor |
| 24-QMHA-R6242 | OR | MD | Case Manager/Care Coordinator |
| 000106008 | OR | MD | Peer Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1674604800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1739145600000",
"number": "1710693544",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5415 SW WESTGATE DR",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972212409",
"telephone_number": "971-727-8026"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5415 SW WESTGATE DR",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972212409",
"telephone_number": "971-727-8026"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HALLORAN",
"first_name": "MARK",
"middle_name": "ANTHONY",
"name_suffix": "Jr.",
"credential": "PSS CRM QMHAR CADCR",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-01-25",
"last_updated": "2025-02-10",
"certification_date": "2025-02-10",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "OR",
"license": "T-24-4760",
"primary": false
},
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "OR",
"license": "000106008",
"primary": false
},
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": "OR",
"license": "24-QMHA-R6242",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRADITIONAL HEALTH WORKER",
"identifier": "000106008",
"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 Feb 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.