Active NPI
Daniel Robert Johnsen
- Community Health Worker
- Portland, OR
National Provider Identifier
1730047655
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- License
- 113538
- Practice address
- 12350 SE Powell Blvd
Portland, OR 97236-3432 - Phone
- (503) 477-2542
- NPI assigned
- Jan 10, 2026
- 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 |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | 113538 | OR | Primary |
Addresses
Primary practice location
12350 SE Powell Blvd
Portland, OR 97236-3432
Mailing address
4546 SE Franklin St
Portland, OR 97206-3115
Phone (503) 477-2542
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 |
|---|---|---|---|
| 113538 | OR | MD | Community Health Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1768003200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1768003200000",
"number": "1730047655",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4546 SE FRANKLIN ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972063115",
"telephone_number": "503-477-2542"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12350 SE POWELL BLVD",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972363432",
"telephone_number": "503-477-2542"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSEN",
"first_name": "DANIEL",
"middle_name": "ROBERT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2026-01-10",
"last_updated": "2026-01-10",
"certification_date": "2026-01-10",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "OR",
"license": "113538",
"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 Jan 10, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.