Individual provider Active NPI

John Kent Neiheisel, MSW

  • Clinical Social Worker
  • Portland, OR
National Provider Identifier
1841359601
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
0570 Issued in OR
Practice address
1962 NW Kearney St Ste L102
Portland, OR 97209-1459
Phone
(503) 525-1148
Fax
(503) 295-7898
NPI assigned
Dec 7, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 0570 OR Primary

Addresses

Primary practice location

1962 NW Kearney St Ste L102
Portland, OR 97209-1459

Mailing address

4403 SW 47TH Dr
Portland, OR 97221-3734
Phone (503) 227-4722

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
I20090928000761 OR Practitioner - Clinical Social Worker 7719033059 Practice locations: Portland, OR

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1978
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

1962 NW Kearney St
Suite 102
Portland, OR 97209-1466
Phone (503) 525-1148

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0570ORMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1165449600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1841359601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4403 SW 47TH DR",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972213734",
            "telephone_number": "503-227-4722",
            "fax_number": "503-295-7898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1962 NW KEARNEY ST STE L102",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972091459",
            "telephone_number": "503-525-1148",
            "fax_number": "503-295-7898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NEIHEISEL",
        "first_name": "JOHN",
        "middle_name": "KENT",
        "name_prefix": "Mr.",
        "credential": "MSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "0570",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.