MRS. AMY L BRISTOW (NPI# 1659937852) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659937852 |
| Entity Type | Individual |
| Full Name | MRS. AMY L BRISTOW |
| Credential | CRM |
| Practice Address |
125 Sw C St Madras OR 97741-1458 |
| Practice Telephone | 5413064566 |
| Practice Fax Number | 5413209005 |
| Mailing Telephone | 5413064566 |
| Mailing Fax Number | 5413209005 |
| Enumeration Date | 2019-05-13 |
| Last Update Date | 2019-05-13 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 175T00000X | Peer Specialist | 19-CRM-100 | OR | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | CERTIFIED RECOVERY MENTOR | 19-CRM-100 | 01 |
| Street Address |
125 SW C ST |
| City | MADRAS |
| State | OR |
| Zip Code | 97741-1458 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215008354 | William Steven Herz | Psychiatry & Neurology | 125 Sw C St, Madras, OR 97741-1458 | 2006-11-12 |
| 1124646401 | Tammi Beard | Peer Specialist | 125 Sw C St, Madras, OR 97741-1458 | 2020-07-13 |
| 1811528573 | Jennifer A Cleem | Peer Specialist | 125 Sw C St, Madras, OR 97741-1458 | 2020-01-31 |
| 1326679085 | Erin M Boyd | Peer Specialist | 125 Sw C St, Madras, OR 97741-1458 | 2020-01-31 |
| 1568021855 | Brandon L Cleem | Peer Specialist | 125 Sw C St, Madras, OR 97741-1458 | 2019-06-10 |
| 1033672613 | Gabrielle M Meese | Counselor | 125 Sw C St, Madras, OR 97741-1458 | 2019-04-10 |
| 1104383645 | Markell Peterson | Counselor | 125 Sw C St, Madras, OR 97741-1458 | 2019-02-20 |
| 1588120448 | Cayla N Pearson | Peer Specialist | 125 Sw C St, Madras, OR 97741-1458 | 2019-02-15 |
| 1831655794 | Mischell B Espinoza | Peer Specialist | 125 Sw C St, Madras, OR 97741-1458 | 2019-02-15 |
| 1750852505 | Imer Gutierrez | Peer Specialist | 125 Sw C St, Madras, OR 97741-1458 | 2018-12-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750868196 | Orie Made | Counselor | 185 Nw D St, Suite D&e, Madras, OR 97741 | 2018-07-27 |
| 1831514603 | Robbin Webber Foster | Social Worker | 470 Ne 'a' St., St. Charles Hospice, Madras, OR 97741 | 2014-03-03 |
| 1184055931 | Sue Lillian Dixon | Nurse Practitioner | 715 S.w. 4th St., Ste.c, Madras, OR 97741 | 2013-12-04 |
| 1255769667 | Aaron Michael Lee | Physician Assistant | 76 N.e. 12th St., Madras, OR 97741 | 2013-10-22 |
| 1114276045 | April A Henselman Campanella | Dental Hygienist | 376 Ne Oak Street, Madras, OR 97741 | 2012-09-06 |
| 1487809091 | Bestcare Treatment Services | Substance Abuse Rehabilitation Facility | 125 Sw C Street, Madras, OR 97741 | 2008-11-24 |
| 1144417437 | Assisted Living Concepts Inc | Assisted Living Facility | 470 Ne Oak Street, Madras, OR 97741 | 2007-10-01 |
| 1518074327 | Janice K Monroe | Nurse Practitioner | 910 Sw Hwy 97, Suite 101, Madras, OR 97741 | 2006-08-25 |
| 1215966759 | Mark M Mullins | Chiropractor | 28 Ne 12th St, Madras, OR 97741 | 2006-06-30 |
| 1356389894 | St. Charles Health System, Inc. | Emergency Medicine | 470 Ne A Street, Madras, OR 97741 | 2006-06-04 |
| Find all providers in zip 97741 | ||||
| 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 |
|---|---|---|---|---|
| 1487263844 | Marina Yancey | Peer Specialist | 850 Sw 4th St, Madras, OR 97741-9628 | 2020-07-30 |
| 1124646401 | Tammi Beard | Peer Specialist | 125 Sw C St, Madras, OR 97741-1458 | 2020-07-13 |
| 1811528573 | Jennifer A Cleem | Peer Specialist | 125 Sw C St, Madras, OR 97741-1458 | 2020-01-31 |
| 1326679085 | Erin M Boyd | Peer Specialist | 125 Sw C St, Madras, OR 97741-1458 | 2020-01-31 |
| 1750942975 | Amy Caudill | Peer Specialist | 850 Sw 4th St, Madras, OR 97741-9628 | 2019-06-27 |
| 1568021855 | Brandon L Cleem | Peer Specialist | 125 Sw C St, Madras, OR 97741-1458 | 2019-06-10 |
| 1588120448 | Cayla N Pearson | Peer Specialist | 125 Sw C St, Madras, OR 97741-1458 | 2019-02-15 |
| 1831655794 | Mischell B Espinoza | Peer Specialist | 125 Sw C St, Madras, OR 97741-1458 | 2019-02-15 |
| 1750852505 | Imer Gutierrez | Peer Specialist | 125 Sw C St, Madras, OR 97741-1458 | 2018-12-05 |
| 1427558485 | Chandler Cruise | Peer Specialist | 850 Sw 4th St, Madras, OR 97741-9628 | 2018-02-16 |
| Find all providers in MADRAS | ||||
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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.