NPIMap

Organization Active NPI

Well Coast Psychiatric Inc. a Nursing Corp

  • Psychiatry Physician
  • Tigard, OR
National Provider Identifier
1841784725
Registry record updated Jul 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
WELL COAST PSYCHIATRIC INC. A NURSING CORP
Practice address
10260 SW Greenburg Rd FL 4
Tigard, OR 97223-5500
Phone
(888) 923-5486
Fax
(866) 225-9111
NPI assigned
Jun 14, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2022

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

Authorized official

Name
Erik Lee, PMHNPNPI 1699110890
Title
Owner
Phone
(888) 923-5486

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X Primary
Psychiatric/Mental Health Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LP0808X NP95002431 CA

Addresses

Primary practice location

10260 SW Greenburg Rd FL 4
Tigard, OR 97223-5500

Mailing address

11575 SW Pacific Hwy # 40452
Tigard, OR 97223-8671
Phone (888) 923-5486

Other practice location 1

10620 Treena St Ste 230
San Diego, CA 92131-1140
Phone (619) 374-8131

Other practice location 2

1390 Market St Ste 200
San Francisco, CA 94102-5404
Phone (619) 374-8131

Other identifiers 1

IdentifierTypeStateIssuer
1699110890OtherNPI

Other names 2

  • Celium Healthcare Doing business as
  • Well Coast Psychiatric Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, OR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20181206000926 CA Part B Supplier - Clinic/Group Practice 4789928433 Receives reassigned benefits from 1 practitioner
Practice locations: San Diego, CA; San Francisco, CA
O20210812001511 OR Part B Supplier - Clinic/Group Practice 4789928433 Receives reassigned benefits from 1 practitioner
Practice locations: Portland, OR

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

1455 Frazee Rd
Ste 500
San Diego, CA 92108
Phone (619) 335-8295

6161 El Cajon Blvd
Ste B458
San Diego, CA 92115

582 Market St
Ste 1608
San Francisco, CA 94104
Phone (415) 521-1506

Practitioners & affiliated clinicians

Practitioners 41

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 41

NPI Registry JSON

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

{
    "created_epoch": "1528934400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658016000000",
    "number": "1841784725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11575 SW PACIFIC HWY # 40452",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972238671",
            "telephone_number": "888-923-5486",
            "fax_number": "866-225-9111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10260 SW GREENBURG RD FL 4",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972235500",
            "telephone_number": "888-923-5486",
            "fax_number": "866-225-9111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10620 Treena St Ste 230",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921311140",
            "country_code": "US",
            "telephone_number": "619-374-8131",
            "fax_number": "415-366-0381",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1390 Market St Ste 200",
            "address_purpose": "LOCATION",
            "city": "San Francisco",
            "state": "CA",
            "postal_code": "941025404",
            "country_code": "US",
            "telephone_number": "619-374-8131",
            "fax_number": "415-366-0381",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WELL COAST PSYCHIATRIC INC. A NURSING CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-14",
        "last_updated": "2022-07-17",
        "certification_date": "2022-07-17",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "ERIK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "888-923-5486",
        "authorized_official_credential": "PMHNP"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "NP95002431",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1699110890",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Celium Healthcare",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Well Coast Psychiatric",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Well Coast Psychiatric",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tigard, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.