Active NPI
Jonathan L Roeder
- Peer Specialist
- Salem, OR
National Provider Identifier
1871129502
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- License
- THW000004071
- Practice address
- 4275 Commercial St SE Ste 180
Salem, OR 97302-4087 - Phone
- (806) 850-3363
- NPI assigned
- Mar 13, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | THW000004071 | OR | Primary |
Addresses
Primary practice location
4275 Commercial St SE Ste 180
Salem, OR 97302-4087
Mailing address
4275 Commercial St SE Ste 180
Salem, OR 97302-4087
Phone (806) 850-3363
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| THW000004071 | Other | OR | TRADITIONAL HEALTH CARE WORKER |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| THW000004071 | OR | MD | Peer Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1584057600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1584057600000",
"number": "1871129502",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4275 COMMERCIAL ST SE STE 180",
"city": "SALEM",
"state": "OR",
"postal_code": "973024087",
"telephone_number": "806-850-3363"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4275 COMMERCIAL ST SE STE 180",
"city": "SALEM",
"state": "OR",
"postal_code": "973024087",
"telephone_number": "806-850-3363"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROEDER",
"first_name": "JONATHAN",
"middle_name": "L",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-03-13",
"last_updated": "2020-03-13",
"certification_date": "2020-03-13",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "OR",
"license": "THW000004071",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRADITIONAL HEALTH CARE WORKER",
"identifier": "THW000004071",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Salem, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.