BENJAMIN CLARK (NPI# 1770871113) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770871113 |
| Entity Type | Individual |
| Full Name | BENJAMIN CLARK |
| Credential | CPO |
| Practice Address |
17316 Ne Halsey St Portland OR 97230-6026 |
| Practice Telephone | 5032576623 |
| Mailing Telephone | 5032576623 |
| Enumeration Date | 2011-07-19 |
| Last Update Date | 2018-03-01 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 222Z00000X | Orthotist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
| Y | 224P00000X | Prosthetist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548750110 | Benjamin Addril Clark | Pharmacist | Se Regional Pharmacy Attn: Ben Clark, 300 First Avenue South, Reidsville, GA 30453 | 2018-05-18 |
| 1285189704 | Benjamin Clark | Physical Therapist | 4501 Main St Ste 5, Shallotte, NC 28470-4585 | 2016-08-25 |
| 1275931479 | Benjamin Brian Clark | Physical Therapist | 7909 Forrest Ave, Belton, MO 64012-5303 | 2014-12-22 |
| 1831400894 | Benjamin T Clark | Family Medicine | 35945 N Gary Rd, San Tan Valley, AZ 85143-5748 | 2010-06-24 |
| 1497708572 | Benjamin S Clark | Nurse Practitioner | 1861 Main Street, Sneedville, TN 37869 | 2006-05-18 |
| 1598743627 | Benjamin Todd Clark | Dentist | 52 Medical Group, Unit 3690, Apo, AE 09126 | 2006-01-09 |
| 1730680232 | Benjamin Jonah Clark | Case Manager/Care Coordinator | 344 E 100 S Ste 301, Salt Lake City, UT 84111-1727 | 2018-02-21 |
| 1851773196 | Benjamin Clark | General Practice | 3288 Moanalua Rd, Honolulu, HI 96819 | 2015-06-23 |
| 1699180448 | Benjamin Allen Clark | Dentist | 1220 N Washington Ave, Durant, OK 74701-2120 | 2014-06-30 |
| 1790105674 | Benjamin Joseph Clark | Internal Medicine | 6431 Fannin St, Houston, TX 77030-1501 | 2014-04-18 |
| Street Address |
17316 NE HALSEY ST |
| City | PORTLAND |
| State | OR |
| Zip Code | 97230-6026 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386602621 | East Side Orthotics & Prosthetics | Prosthetic/Orthotic Supplier | 17316 Ne Halsey St, Portland, OR 97230-6026 | 2006-05-03 |
| 1023497526 | Jeffery Warila | Orthotist | 17316 Ne Halsey St, Portland, OR 97230-6026 | 2015-05-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932687233 | Timisha K Wilson | Social Worker | 12505 Ne Halsey St, Portland, OR 97230 | 2018-07-30 |
| 1356828768 | Sally Gail Logan | Pharmacist | 5725 Ne 138th Avenue, Portland, OR 97230 | 2018-07-27 |
| 1063937951 | Marley Elizabeth Small | Counselor | 1507 Ne 122nd Ave., Portland, OR 97230 | 2017-08-11 |
| 1447771316 | Shadab Nasreen Aijazi | Pathology | 5220 Ne 122nd Avenue, Portland, OR 97230 | 2017-06-30 |
| 1104378199 | Derek Andrus | Pharmacist | 5717 Nw 138th, Portland, OR 97230 | 2016-10-26 |
| 1164972675 | Rachael Anderson | Adult Companion | 423 Ne 160th Ave #11, Portland, OR 97230 | 2016-10-07 |
| 1750837597 | Providence Elderplace | Assisted Living Facility | 16430 Ne Hoyt St, Portland, OR 97230 | 2016-08-31 |
| 1649622473 | Sara Mcgroarty | Counselor | 17710 Ne Halsey Street, Portland, OR 97230 | 2016-07-05 |
| 1346699949 | Steven D Stanton | Counselor | 1022 Ne 181st Ave, C1, Portland, OR 97230 | 2016-06-06 |
| 1215390091 | The Wallace Medical Concern | Clinic/Center | 18139 Ne Couch Street, Portland, OR 97230 | 2016-03-30 |
| Find all providers in zip 97230 | ||||
| Taxonomy Code | 224P00000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Prosthetist |
| A health care professional who is specifically educated and trained to manage comprehensive prosthetic patient care for individuals who have sustained complete or partial limb loss or absence. Prosthetists assess specific patient needs, formulate an appropriate treatment plan, implement the treatment plan and provide follow-up care. |
| Notes: Source: American Board for Certification in Orthotics, Prosthetics, and Pedorthics, Inc. [7/1/2010: modified, 7/1/2013: modified] Additional Resources: American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc., www.abcop.org and Board of Certification/Accreditation, International, www.bocusa.org. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477868297 | Joel G Rinta | Prosthetist | 1627 Ne Broadway, Portland, OR 97232-1425 | 2010-08-17 |
| 1356840821 | Kevyn Maxwell Mcghee | Prosthetist | 3710 Sw Us Veterans Hospital Rd, Portland, OR 97239-2964 | 2018-02-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396254306 | Steven Gotfredson | Prosthetist | 4438 Se Jefferson St, Milwaukie, OR 97222-5342 | 2017-09-21 |
| 1154845204 | Jude Regan Elliott | Prosthetist | 675 12th St Se, Salem, OR 97301-4002 | 2017-07-31 |
| 1508179516 | Brentt Ramharter | Prosthetist | 2200 Ne Neff Rd, Suite 306, Bend, OR 97701-4283 | 2010-07-19 |
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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.