Billy L. Boynton, CRM
Individual provider Active NPI Peer Specialist · Madras, OR
NPI 1801490396 · NPPES record last updated Feb 20, 2023
Key facts
- NPI
- 1801490396
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Peer Specialist 175T00000X
- License
- 20-CRM-295 (OR)
- Practice address
- 850 SW 4TH St
Madras, OR 97741-9628 - Phone
- (541) 475-4822
- NPI assigned
- Nov 24, 2020
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20-CRM-295 | OR | MD | Peer Specialist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | 20-CRM-295 | OR | Yes |
Addresses
Primary practice location
850 SW 4TH St
Madras, OR 97741-9628
Mailing address
850 SW 4TH St
Madras, OR 97741-9628
Phone (541) 475-4822
Other providers in Madras, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 20, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.