NPIMap

Organization Active NPI

Watershed Community Wellness LLC

  • Acupuncturist
  • Portland, OR
National Provider Identifier
1932436896
Registry record updated Jan 20, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
AcupuncturistTaxonomy code 171100000X
License
AC150225 Issued in OR
Legal business name
WATERSHED COMMUNITY WELLNESS LLC
Practice address
1988 SE Ladd Ave
Portland, OR 97214-4737
Phone
(503) 820-8040
Fax
(503) 564-0180
NPI assigned
Nov 12, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2011

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

Authorized official

Name
Mr. Eric Benjamin Grey, LACNPI 1689907875
Title
Member
Phone
(503) 820-8040

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
AcupuncturistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 171100000X AC150225 OR Primary
MechanotherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 172M00000X 12190 OR

Addresses

Primary practice location

1988 SE Ladd Ave
Portland, OR 97214-4737

Mailing address

1988 SE Ladd Ave
Portland, OR 97214-4737
Phone (503) 820-8040

Other names 1

  • Watershed Community Wellness Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Watershed Community Wellness LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1988 SE Ladd Ave
Portland, OR 97214
Phone (503) 820-8040

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1257984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1295481600000",
    "number": "1932436896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1988 SE LADD AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972144737",
            "telephone_number": "503-820-8040",
            "fax_number": "503-564-0180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1988 SE LADD AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972144737",
            "telephone_number": "503-820-8040",
            "fax_number": "503-564-0180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATERSHED COMMUNITY WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-12",
        "last_updated": "2011-01-20",
        "status": "A",
        "authorized_official_last_name": "GREY",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "BENJAMIN",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "503-820-8040",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LAC"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Acupuncturist",
            "state": "OR",
            "license": "AC150225",
            "primary": true
        },
        {
            "code": "172M00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Mechanotherapist",
            "state": "OR",
            "license": "12190",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Watershed Community Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2011; 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.