Individual provider Active NPI

J Workman-Purvine, LCSW

  • Clinical Social Worker
  • Portland, OR
National Provider Identifier
1851689368
Registry record updated Jun 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
L5170 Issued in OR
Practice address
7334 N Chicago Ave
Portland, OR 97203-4869
Phone
(503) 928-7491
NPI assigned
Jul 18, 2011
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 5, 2020

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 L5170 OR Primary

Addresses

Primary practice location

7334 N Chicago Ave
Portland, OR 97203-4869

Mailing address

7334 N Chicago Ave
Portland, OR 97203-4869
Phone (503) 201-1614

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
I20130409000291 OR Practitioner - Clinical Social Worker 5698911006

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Heartful Path Therapy Clinical CurrentSince Jun 2, 2013 Accepting new patients

Locations

7334 N Chicago Ave
Portland, OR 97203
Phone (503) 928-7491

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1310947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591315200000",
    "number": "1851689368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7334 N CHICAGO AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972034869",
            "telephone_number": "503-201-1614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7334 N CHICAGO AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972034869",
            "telephone_number": "503-928-7491"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WORKMAN-PURVINE",
        "first_name": "J",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-07-18",
        "last_updated": "2020-06-05",
        "certification_date": "2020-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L5170",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.