NPIMap

Organization Active NPI

Polk County Alcohol and Drug

  • Addiction (Substance Use Disorder) Counselor
  • Dallas, OR
National Provider Identifier
1720013071
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
CERTIFICATE OF APPRO Issued in OR
Legal business name
POLK COUNTY ALCOHOL AND DRUG
Practice address
182 SW Academy
Suite #304
Dallas, OR 97338-1922
Phone
(503) 623-9289
Fax
(503) 831-1726
NPI assigned
Jul 12, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Greg P Hansen
Title
Polk County Administrative Officer
Phone
(503) 623-8173

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YA0400X CERTIFICATE OF APPRO OR Primary

Addresses

Primary practice location

182 SW Academy
Suite #304
Dallas, OR 97338-1922

Mailing address

182 SW Academy St
Suite #310 Polk County Alcohol and Drug
Dallas, OR 97338-1922
Phone (503) 623-9317

Other identifiers 1

IdentifierTypeStateIssuer
132001MedicaidOR

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040405001567 OR Part B Supplier - Clinic/Group Practice 7315930492 Receives reassigned benefits from 10 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Dallas, OR; Independence, OR; Monmouth, OR; Salem, OR

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
Polk County Health Depart11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1720013071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "182 SW ACADEMY ST",
            "address_2": "SUITE #310 POLK COUNTY ALCOHOL AND DRUG",
            "city": "DALLAS",
            "state": "OR",
            "postal_code": "973381922",
            "telephone_number": "503-623-9317",
            "fax_number": "503-623-2731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "182 SW ACADEMY",
            "address_2": "SUITE #304",
            "city": "DALLAS",
            "state": "OR",
            "postal_code": "973381922",
            "telephone_number": "503-623-9289",
            "fax_number": "503-831-1726"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POLK COUNTY ALCOHOL AND DRUG",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HANSEN",
        "authorized_official_first_name": "GREG",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "POLK COUNTY ADMINISTRATIVE OFFICER",
        "authorized_official_telephone_number": "503-623-8173",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OR",
            "license": "CERTIFICATE OF APPRO",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "132001",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.