PETER THOMAS CONNOLLY (NPI# 1760739205) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760739205 |
| Entity Type | Individual |
| Full Name | PETER THOMAS CONNOLLY |
| Practice Address |
7621 N Portsmouth Ave Portland OR 97203-5953 |
| Mailing Address |
Po Box 8459 Portland OR 97207-8459 |
| Practice Telephone | 5032407599 |
| Mailing Telephone | 5032380769 |
| Enumeration Date | 2012-08-14 |
| Last Update Date | 2020-01-14 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 171M00000X | Case Manager/Care Coordinator | OR | Other Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871620740 | Peter Nelson Connolly | Specialist | 195 1st Pl Nw, Suite 1, Issaquah, WA 98027-3285 | 2007-02-27 |
| 1104066356 | Peter Connolly | Surgery | 525 E 68th St, Payson-7, New York, NY 10065-4870 | 2009-03-01 |
| 1083626824 | Peter Connolly | Internal Medicine | 20 Squadron Blvd, New City, NY 10956-5200 | 2006-08-12 |
| 1376534909 | Peter Connolly | Internal Medicine | 145 Ward Hill Ave, Whittier Rehab, Bradford, MA 01835 | 2005-11-02 |
| Street Address |
7621 N PORTSMOUTH AVE |
| City | PORTLAND |
| State | OR |
| Zip Code | 97203-5953 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447337753 | Cascadia Behavioral Healthcare Inc | Clinic/Center | 7621 N Portsmouth Ave, Portland, OR 97203-5953 | 2006-11-01 |
| 1851918965 | Jeffrey Alan Miller | Case Manager/Care Coordinator | 7621 N Portsmouth Ave, Portland, OR 97203-5953 | 2020-07-06 |
| 1912521964 | Cameron D Palm | Technician | 7621 N Portsmouth Ave, Portland, OR 97203-5953 | 2020-06-05 |
| 1215550488 | Madison L Tindle | Case Manager/Care Coordinator | 7621 N Portsmouth Ave, Portland, OR 97203-5953 | 2020-05-22 |
| 1669094744 | Carlos A Molina | Technician | 7621 N Portsmouth Ave, Portland, OR 97203-5953 | 2020-05-12 |
| 1104448182 | Marcus Jack Swinkels | Technician | 7621 N Portsmouth Ave, Portland, OR 97203-5953 | 2020-05-12 |
| 1689212284 | Ronda M Potts-bailey | Adult Companion | 7621 N Portsmouth Ave, Portland, OR 97203-5953 | 2019-12-13 |
| 1528426632 | Jenni Lovell | Counselor | 7621 N Portsmouth Ave, Portland, OR 97203-5953 | 2016-02-03 |
| 1235535345 | Motlalepula Naanyane | Counselor | 7621 N Portsmouth Ave, Portland, OR 97203-5953 | 2014-11-17 |
| 1912307174 | Devin Collins | Adult Companion | 7621 N Portsmouth Ave, Portland, OR 97203-5953 | 2014-08-25 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952923757 | Justin Cummings | Meals | 10105 N. Oswego Ave, Portland, OR 97203 | 2020-05-14 |
| 1407335045 | Gage Solis | Student in an Organized Health Care Education/Training Program | 8425 N. Lombard St, Portland, OR 97203 | 2018-08-13 |
| 1497103493 | Ruby Diane Ciarlante | Community Health Worker | 7803 N Portsmouth Ave, Portland, OR 97203 | 2016-05-31 |
| 1992139620 | Hannah Clare | Speech-Language Pathologist | 7126 N Amherst St, Portland, OR 97203 | 2013-08-29 |
| 1043656713 | Heather Ranae Mcintosh | Social Worker | 7323 N Burlington Ave, Portland, OR 97203 | 2013-05-21 |
| 1275879363 | Matthew Scott Bennett | Pharmacist | 6850 N. Lombard, Portland, OR 97203 | 2012-12-18 |
| 1144594094 | Candice Juliet Thomas | Pharmacist | 9000 N. Lombard St, Portland, OR 97203 | 2012-02-23 |
| 1093013211 | Aarisa Elysianne Smith | Mechanotherapist | 8438 N Lombard St, Ste 7, Portland, OR 97203 | 2011-03-11 |
| 1700103546 | Lisa Catherine Davis | Acupuncturist | 1614 Ne Alberta Street, Portland, OR 97203 | 2010-05-03 |
| 1427298579 | Donald Marvin Lorenzen | Denturist | 8530 N. Ivanhoe, Portland, OR 97203 | 2009-03-03 |
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| Taxonomy Code | 171M00000X |
| Grouping | Other Service Providers |
| Classification | Case Manager/Care Coordinator |
| A person who provides case management services and assists an individual in gaining access to needed medical, social, educational, and/or other services. The person has the ability to provide an assessment and review of completed plan of care on a periodic basis. This person is also able to take collaborative action to coordinate the services with other providers and monitor the enrollee’s progress toward the cost-effective achievement of objectives specified in the plan of care. Credentials may vary from an experience in the fields of psychology, social work, rehabilitation, nursing or a closely related human service field, to a related Assoc of Arts Degree or to nursing credentials. Some states may require certification in case management. |
| Notes: Source: CMS State Medicaid Manual Section 4442.3 [7/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437775558 | John Alan Varner | Case Manager/Care Coordinator | 5833 N Lombard St, Portland, OR 97203-4115 | 2020-06-24 |
| 1750906228 | Dwell Care LLC. | Case Manager/Care Coordinator | 1720 Nw Lovejoy St Ste 202, Portland, OR 97209-2341 | 2020-06-10 |
| 1871138453 | Kedrick Starr | Case Manager/Care Coordinator | 14600 Nw Cornell Rd., Portland, OR 97229 | 2019-11-07 |
| 1477102077 | Joslyn Bailey Gheen | Case Manager/Care Coordinator | 1032 Sw Main St, Portland, OR 97205-2407 | 2019-09-05 |
| 1497311773 | Ali Tareq Ashour | Case Manager/Care Coordinator | 980 Forest Ave Ste 106, Portland, ME 04103-3357 | 2019-05-13 |
| 1427540202 | Amber Tracy Ware | Case Manager/Care Coordinator | 30 Ne Martin Luther King Jr Blvd, Portland, OR 97232-2941 | 2018-06-06 |
| 1710479209 | Katherine Anne Kerr | Case Manager/Care Coordinator | 4307 Ne 102nd Ave, Portland, OR 97220-3439 | 2018-05-31 |
| 1194230664 | Ankita Guchait | Case Manager/Care Coordinator | 14600 Nw Cornell Rd, Portland, OR 97229 | 2017-12-06 |
| 1083137459 | David Sague | Case Manager/Care Coordinator | 7820 Ne Holman St Ste B5, Portland, OR 97218-2841 | 2017-07-18 |
| 1538601885 | Gabriela Simone Sargent | Case Manager/Care Coordinator | 4109 Se 113th Ave, Portland, OR 97266-2226 | 2016-11-16 |
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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.