Active NPI
Michael Alan Nicholas, CRM
- Peer Specialist
- Oregon City, OR
National Provider Identifier
1821537861
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- License
- 15-CRM-008
- Practice address
- 704 Main St
Oregon City, OR 97045-1842 - Phone
- (971) 386-3415
- Fax
- (503) 208-2596
- NPI assigned
- Feb 22, 2017
- 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 |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | 15-CRM-008 | OR | Primary |
Addresses
Primary practice location
704 Main St
Oregon City, OR 97045-1842
Mailing address
PO Box 16756
Portland, OR 97292-0756
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 |
|---|---|---|---|
| 15-CRM-008 | OR | MD | Peer Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1487721600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1487721600000",
"number": "1821537861",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 16756",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972920756",
"fax_number": "503-208-2596"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "704 MAIN ST",
"city": "OREGON CITY",
"state": "OR",
"postal_code": "970451842",
"telephone_number": "971-386-3415",
"fax_number": "503-208-2596"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICHOLAS",
"first_name": "MICHAEL",
"middle_name": "ALAN",
"credential": "CRM",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-02-22",
"last_updated": "2017-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "OR",
"license": "15-CRM-008",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oregon City, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.