Gordon S Macmillan, CRM

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

Practice address

31700 Fayetteville Dr
Shedd, OR 97377-9779

Phone

(503) 208-9004

Fax

(971) 236-8080

NPI assigned

Oct 9, 2023

Last updated

Oct 9, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

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

• Teen Challenge International Pacific Northwest Centers

  dba Life Renewal - Portland Outpatient

  • Community/Behavioral Health Agency
  • Milwaukie, OR
  • NPI 1245784222
  NPD

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

{
    "created_epoch": "1696809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696809600000",
    "number": "1861273617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18600 SE MCLOUGHLIN BLVD",
            "city": "MILWAUKIE",
            "state": "OR",
            "postal_code": "972676723",
            "telephone_number": "971-255-0658",
            "fax_number": "971-236-8080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31700 FAYETTEVILLE DR",
            "city": "SHEDD",
            "state": "OR",
            "postal_code": "973779779",
            "telephone_number": "503-208-9004",
            "fax_number": "971-236-8080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACMILLAN",
        "first_name": "GORDON",
        "middle_name": "S",
        "credential": "CRM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-10-09",
        "last_updated": "2023-10-09",
        "certification_date": "2023-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "OR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kayla Joe Dugger
• Terry Eaton
• David A Fleming, CADC II
• Rob Dean Gerig, MA COUNSELING
• Violet Gott
• Taylor Markham, CRM
• Monty Dale Meyer, PSS
• Heather Elaine Miller, LBD
• Rudy Rodriguez
• Savannah Rose

• Peer Specialist in Shedd, OR
• Providers in Shedd, OR by specialty
• Peer Specialist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2023; 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.