Active NPI
Peggy Lynn Humphries
- Peer Specialist
- Beaverton, OR
National Provider Identifier
1760091839
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- License
- 19-CRM-138
- Practice address
- 10700 SW Beaverton Hillsdale Hwy BLDG 1
Beaverton, OR 97005-3019 - Phone
- (503) 645-9010
- NPI assigned
- Jul 24, 2020
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | 19-CRM-138 | OR | Primary |
Addresses
Primary practice location
10700 SW Beaverton Hillsdale Hwy BLDG 1
Beaverton, OR 97005-3019
Mailing address
5042 S Corbett Ave Apt 7
Portland, OR 97239-3944
Phone (925) 812-4201
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 |
|---|---|---|---|
| 19-CRM-138 | OR | MD | Peer Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1595548800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1595548800000",
"number": "1760091839",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5042 S CORBETT AVE APT 7",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972393944",
"telephone_number": "925-812-4201"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10700 SW BEAVERTON HILLSDALE HWY BLDG 1",
"city": "BEAVERTON",
"state": "OR",
"postal_code": "970053019",
"telephone_number": "503-645-9010"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HUMPHRIES",
"first_name": "PEGGY",
"middle_name": "LYNN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-07-24",
"last_updated": "2020-07-24",
"certification_date": "2020-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "OR",
"license": "19-CRM-138",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Beaverton, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.