CARLOS THOMAS BENSON MARTINEZ (NPI# 1205477783) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205477783 |
| Entity Type | Individual |
| Full Name | CARLOS THOMAS BENSON MARTINEZ |
| Practice Address |
12655 Sw Center St Ste 100 Beaverton OR 97005-1600 |
| Mailing Address |
12577 Se River Rd Apt 139 Milwaukie OR 97222-8007 |
| Practice Telephone | 6173010447 |
| Practice Fax Number | 5038283401 |
| Mailing Telephone | 6173010447 |
| Enumeration Date | 2019-10-04 |
| Last Update Date | 2019-10-04 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 175T00000X | Peer Specialist | THW000003795 | OR | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | THW CERTIFICATION # | THW000003795 | 01 |
| Street Address |
12655 SW CENTER ST STE 100 |
| City | BEAVERTON |
| State | OR |
| Zip Code | 97005-1600 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659730125 | Amanda Hermens | Counselor | 12655 Sw Center St Ste 100, Beaverton, OR 97005-1600 | 2016-02-12 |
| 1336748771 | Sarah Lynn Livengood | Psychologist | 12655 Sw Center St Ste 100, Beaverton, OR 97005-1600 | 2020-10-17 |
| 1710585005 | Klarissa Gaskell | Counselor | 12655 Sw Center St Ste 100, Beaverton, OR 97005-1600 | 2020-10-09 |
| 1649885245 | Mical Ventura | Counselor | 12655 Sw Center St Ste 100, Beaverton, OR 97005-1600 | 2020-09-10 |
| 1922612837 | Hannah Elizabeth Latimer-snell | Counselor | 12655 Sw Center St Ste 100, Beaverton, OR 97005-1600 | 2020-09-08 |
| 1801400742 | Jonathan Willden | Counselor | 12655 Sw Center St Ste 100, Beaverton, OR 97005-1600 | 2020-09-08 |
| 1669090478 | Patrick R Martin | Community/Behavioral Health | 12655 Sw Center St Ste 100, Beaverton, OR 97005-1600 | 2020-07-08 |
| 1669096509 | Alina Grimsted | Student in an Organized Health Care Education/Training Program | 12655 Sw Center St Ste 100, Beaverton, OR 97005-1600 | 2020-06-06 |
| 1356964647 | Molly Elissa Frechette | Counselor | 12655 Sw Center St Ste 100, Beaverton, OR 97005-1600 | 2020-05-21 |
| 1568095339 | Shawn Kevin Hudson | Peer Specialist | 12655 Sw Center St Ste 100, Beaverton, OR 97005-1600 | 2020-02-19 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154945053 | Krista Lowe Schimmelbusch | Student in an Organized Health Care Education/Training Program | 12730 Sw 3rd St., Beaverton, OR 97005 | 2020-06-05 |
| 1346882578 | Mireya Elissa Nunez I | Counselor | 12665 Sw Center Street, Suite 100, Beaverton, OR 97005 | 2019-10-09 |
| 1548816879 | Logan James Patzlaff | Behavior Technician | 6200 Sw Artic Drive Beaverton, Or 97005, Beaverton, OR 97005 | 2019-08-13 |
| 1528521424 | Alex Taylor Foerman | Behavior Technician | 6200 Sw Arctic Drive Beaverton, Or 97005, Beaverton, OR 97005 | 2019-04-09 |
| 1285193003 | Hazelnut Dental LLC | Clinic/Center | 10773 Sw Beaverton-hillsdale Hwy, Ste B, Beaverton, OR 97005 | 2019-03-19 |
| 1992286348 | Kathryn Wallner | Counselor | 14205 Sw Farmington Road, Suite 160, Beaverton, OR 97005 | 2018-08-23 |
| 1699265058 | Meaghan Mikulic | Social Worker | 14355 Sw Allen Blvd Suite 150, Beaverton, OR 97005 | 2018-05-11 |
| 1629568936 | Aimee J Nelson | Massage Therapist | 10700 Sw Beaverton Hillsdale Hwy Ste 465, Beaverton, OR 97005 | 2018-05-11 |
| 1093221780 | Ember Dahl | Massage Therapist | 12655 Sw Center St Ste 530, Beaverton, OR 97005 | 2017-12-18 |
| 1033667456 | Andre Vo | Pharmacist | 2575 Sw Walker Rd, Beaverton, OR 97005 | 2016-09-14 |
| Find all providers in zip 97005 | ||||
| Taxonomy Code | 175T00000X |
| Grouping | Other Service Providers |
| Classification | Peer Specialist |
| Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority. |
| Notes: Source: National Uniform Claim Committee [7/1/2014: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093206757 | Sarah K Hertz | Peer Specialist | 6275 Sw Mad Hatter Ln, Beaverton, OR 97008-8509 | 2018-05-29 |
| 1639555600 | Jennifer Lustbader | Peer Specialist | 14760 Sw Forest Dr, Beaverton, OR 97007-5117 | 2015-07-31 |
| 1578160859 | Rene Hadley | Peer Specialist | 3800 Sw Cedar Hills Blvd, Beaverton, OR 97005-2027 | 2020-10-08 |
| 1760091839 | Peggy Lynn Humphries | Peer Specialist | 10700 Sw Beaverton Hillsdale Hwy Bldg 1, Beaverton, OR 97005-3019 | 2020-07-24 |
| 1568095339 | Shawn Kevin Hudson | Peer Specialist | 12655 Sw Center St Ste 100, Beaverton, OR 97005-1600 | 2020-02-19 |
| 1093359291 | Lujein Solaiman Alkreidi | Peer Specialist | 3800 Sw Cedar Hills Blvd Ste 288, Beaverton, OR 97005-2035 | 2019-10-30 |
| 1871134353 | Bianca Maldonado Ramirez | Peer Specialist | 12655 Sw Center St Ste 100, Beaverton, OR 97005-1600 | 2019-10-04 |
| 1487101648 | Juliana Clark | Peer Specialist | 10700 Sw Beaverton Hillsdale Hwy, Beaverton, OR 97005-3019 | 2016-09-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487255576 | Thomas Roy Hooks | Peer Specialist | 1221 Sw 11th Ave Apt 102, Portland, OR 97205-2143 | 2020-11-04 |
| 1578162145 | Kenneth Branson | Peer Specialist | 389 Sw Scalehouse Ct Ste 130, Bend, OR 97702-3241 | 2020-10-23 |
| 1962000554 | Dawn Marks | Peer Specialist | 21440 Se Stark St, Gresham, OR 97030-2024 | 2020-10-15 |
| 1679188080 | Michelle Marie Bunkers | Peer Specialist | 20517 Jacklight Ln, Bend, OR 97702-2971 | 2020-09-11 |
| 1538773155 | Mamie Nzigire Zagabe | Peer Specialist | 605 Se Cesar Estrada Chavez Blvd, Portland, OR 97214 | 2020-09-01 |
| 1528677820 | Charice Monette | Peer Specialist | 4151 Kacey Cir Ne, Salem, OR 97305-4504 | 2020-07-23 |
| 1841810322 | Ariana Lee May | Peer Specialist | 1601 Olive St Apt 1008, Eugene, OR 97401-3985 | 2020-04-24 |
| 1982237236 | Jessica M Montoya | Peer Specialist | 235 Se Knowledge St, Prineville, OR 97754-2362 | 2020-02-14 |
| 1134752579 | Lisa Kennedy | Peer Specialist | 132 Ne B St # 24, Grants Pass, OR 97526-2114 | 2020-02-13 |
| 1730711953 | Michael Anthony Duran | Peer Specialist | 1515 Hill St Se, Albany, OR 97322-6715 | 2020-02-05 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.