Individual provider Active NPI

Robert Luke Mohlman, LCSW

  • Clinical Social Worker
  • Portland, OR
National Provider Identifier
1730468091
Registry record updated Mar 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
L7197 Issued in OR
Practice address
16083 SW Upper Boones Ferry Rd Ste 130
Portland, OR 97224-7737
Phone
(503) 603-9087
NPI assigned
Aug 4, 2011
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 12, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X L7197 OR Primary

Addresses

Primary practice location

16083 SW Upper Boones Ferry Rd Ste 130
Portland, OR 97224-7737

Mailing address

16083 SW Upper Boones Ferry Rd Ste 130
Portland, OR 97224-7737

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260413001249 OR Practitioner - Clinical Social Worker 9133694615 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2014
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

2023 NW Hoyt St
Portland, OR 97209-1211

2023 NW Hoyt St
Portland, OR 97209-1298

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
L7197ORMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Bridgeport Family Medicine LLC CurrentSince Mar 22, 2020 Accepting new patients
Fornance Physician Services, Inc. PastSince Mar 22, 2020 Accepting new patients

Locations

16083 SW Upper Boones Ferry Rd
Ste 130
Tigard, OR 97224
Phone (503) 603-9087

Interoperability endpoints

  • Direct secure messaging: robert.mohlman@897273817595908.direct.elationemr.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1312416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583971200000",
    "number": "1730468091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16083 SW UPPER BOONES FERRY RD STE 130",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972247737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16083 SW UPPER BOONES FERRY RD STE 130",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972247737",
            "telephone_number": "503-603-9087"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOHLMAN",
        "first_name": "ROBERT",
        "middle_name": "LUKE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-08-04",
        "last_updated": "2020-03-12",
        "certification_date": "2020-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L7197",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.