Jason Southmayd, R.N.

Primary specialty

Psychiatric/Mental Health Registered NurseTaxonomy code 163WP0808X

License

201504773RN Issued in OR

Practice address

4105 SE International Way Ste 501
Milwaukie, OR 97222-8855

Phone

(503) 496-3201

NPI assigned

Jul 14, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

Practice roles

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.

• Lifeworks NW

  • Mental Health Counselor
  • Portland, OR
  • NPI 1467408013
  NPD (past)

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

{
    "created_epoch": "1468454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1468454400000",
    "number": "1730532649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14600 NW CORNELL RD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972295442",
            "telephone_number": "503-645-3581",
            "fax_number": "503-690-9605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4105 SE INTERNATIONAL WAY STE 501",
            "city": "MILWAUKIE",
            "state": "OR",
            "postal_code": "972228855",
            "telephone_number": "503-496-3201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOUTHMAYD",
        "first_name": "JASON",
        "credential": "R.N.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-07-14",
        "last_updated": "2016-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OR",
            "license": "201504773RN",
            "primary": false
        },
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "OR",
            "license": "201504773RN",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fritzie Cristobal Soriano, PHYSICAL THERAPIST
• Linda Wong Soriano, PTA
• Anthony Rene Soto
• Soul to Soul Ihca
• Jennifer Lynn Sousley, PTA
• Ronald Lee Spangler, MD
• Linda Eileen Speizer, PHYSICAL THERAPIST
• Eleni Speropulos
• Scott Spicer
• Samson John Spilk Wall, MD

• Psychiatric/Mental Health Registered Nurse in Milwaukie, OR
• Providers in Milwaukie, OR by specialty
• Psychiatric/Mental Health Registered Nurse in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.