Travis R Tiede, APRN

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

10016365 Issued in OR

Practice address

12360 SE Sunnyside Rd
Clackamas, OR 97015-9320

Phone

(503) 303-4000

NPI assigned

Mar 4, 2024

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

Enrolled in OR

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2023

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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 and National Provider Directory roles.

• Cascadia Health

  • Multi-Specialty Clinic/Center
  • Portland, OR
  • NPI 1336196401
  Medicare reassignment NPD
• Cascadia Health

  • Primary Care Clinic/Center
  • Portland, OR
  • NPI 1144722935
  NPD

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

{
    "created_epoch": "1709510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709510400000",
    "number": "1962269332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11827 SE WHITE TAIL DR",
            "city": "HAPPY VALLEY",
            "state": "OR",
            "postal_code": "970864722",
            "telephone_number": "612-703-5277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12360 SE SUNNYSIDE RD",
            "city": "CLACKAMAS",
            "state": "OR",
            "postal_code": "970159320",
            "telephone_number": "503-303-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIEDE",
        "first_name": "TRAVIS",
        "middle_name": "R",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-03-04",
        "last_updated": "2024-03-04",
        "certification_date": "2024-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OR",
            "license": "10016365",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Caroline Keziah Thiongo
• Sean Eric Thompson, CRNA
• James G. Thornburg, D.C.
• Kathy Thurow, RRT
• Ashley B Tidwell
• Elise Karlan Timtim, MD
• Kathryn Rose Tinkler, R.PH., PHARM. D.
• To the Point Bodywork LLC
• Thomas Roderick Toal Jr., MD
• Stephanie Davies Hunt Toder, M.D.

• Psychiatric/Mental Health Nurse Practitioner in Clackamas, OR
• Providers in Clackamas, OR by specialty
• Psychiatric/Mental Health Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.