Individual provider Active NPI

James M Henneman

  • Mental Illness Community Based Residential Treatment Facility
  • Beaverton, OR
National Provider Identifier
1851226526
Registry record updated Jun 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
License
100085 Issued in OR
Practice address
19600 SW Stacey St
Beaverton, OR 97003-2520
Phone
(503) 649-6287
Fax
(503) 591-7489
NPI assigned
Jun 15, 2026
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 15, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X 100085 OR Primary

Addresses

Primary practice location

19600 SW Stacey St
Beaverton, OR 97003-2520

Mailing address

19600 SW Stacey St
Beaverton, OR 97003-2520
Phone (503) 649-6287

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

NPI Registry JSON

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

{
    "created_epoch": "1781481600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1781481600000",
    "number": "1851226526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19600 SW STACEY ST",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970032520",
            "telephone_number": "503-649-6287",
            "fax_number": "503-591-7489"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19600 SW STACEY ST",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970032520",
            "telephone_number": "503-649-6287",
            "fax_number": "503-591-7489"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENNEMAN",
        "first_name": "JAMES",
        "middle_name": "M",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2026-06-15",
        "last_updated": "2026-06-15",
        "certification_date": "2026-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "OR",
            "license": "100085",
            "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 Jun 15, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.