JEFFREY T HOLM (NPI# 1063050763) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063050763 |
| Entity Type | Individual |
| Full Name | JEFFREY T HOLM |
| Practice Address |
5120 Se 118th Ave Portland OR 97266-3250 |
| Mailing Address |
Po Box 8459 Portland OR 97207-8459 |
| Practice Telephone | 5037623431 |
| Enumeration Date | 2019-12-13 |
| Last Update Date | 2019-12-13 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 171M00000X | Case Manager/Care Coordinator | Other Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477039725 | Jeffrey Holm | Pharmacist | 1167 E Clinton Trl, Charlotte, MI 48813-7318 | 2018-07-18 |
| Street Address |
5120 SE 118TH AVE |
| City | PORTLAND |
| State | OR |
| Zip Code | 97266-3250 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386798833 | Donald Joseph Hice | Counselor | 5120 Se 118th Ave, Portland, OR 97266-3250 | 2007-01-22 |
| 1669099768 | Premier Living Center Inc. | Assisted Living Facility | 5120 Se 118th Ave, Portland, OR 97266-3250 | 2020-07-06 |
| 1609111590 | Katrina Eerkes | Case Manager/Care Coordinator | 5120 Se 118th Ave, Portland, OR 97266-3250 | 2012-12-03 |
| 1780959593 | Jacqueline V Swofford | Case Manager/Care Coordinator | 5120 Se 118th Ave, Portland, OR 97266-3250 | 2012-03-12 |
| 1144598822 | Corey Dean Anderson | Counselor | 5120 Se 118th Ave, Portland, OR 97266-3250 | 2011-12-08 |
| 1902051139 | Michelle Martin | Adult Companion | 5120 Se 118th Ave, Portland, OR 97266-3250 | 2008-12-02 |
| 1447415336 | Lawrence Lindstrom Ruhf | Counselor | 5120 Se 118th Ave, Portland, OR 97266-3250 | 2008-07-21 |
| 1124298724 | Teresa Barker | Case Manager/Care Coordinator | 5120 Se 118th Ave, Portland, OR 97266-3250 | 2008-03-10 |
| 1043493737 | Jacob White | Case Manager/Care Coordinator | 5120 Se 118th Ave, Portland, OR 97266-3250 | 2007-12-17 |
| 1598895708 | Jennifer Ashley Phillips IIi | Case Manager/Care Coordinator | 5120 Se 118th Ave, Portland, OR 97266-3250 | 2007-03-06 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528545969 | Willamette Pharmacy | Pharmacy | 10209 Se Division Build B Ste 100, Portland, OR 97266 | 2018-07-27 |
| 1992204697 | Sober Living Oregon Treatment Center | Clinic/Center | 10209 Se Division, Portland, OR 97266 | 2018-02-08 |
| 1699204024 | Malori Christine Butler | Registered Nurse | 7335 Se 85th Ave., Portland, OR 97266 | 2017-06-08 |
| 1487028882 | Emil Kunkel | Naturopath | 6318 Se 87th Ave, Portland, OR 97266 | 2015-11-23 |
| 1194195313 | Cory Hall-martin | Counselor | 10011 Se Division St #305, Portland, OR 97266 | 2015-09-30 |
| 1336517721 | Krispin Mayfield | Counselor | 10011 Se Division St., Suite 203, Portland, OR 97266 | 2015-09-02 |
| 1407247927 | Syrena Nicholson | Community Health Worker | 7721 Se 92nd Avenue, Apt K, Portland, OR 97266 | 2015-02-06 |
| 1659777886 | Berhanu Aynalem Mekbib | Adult Companion | 9125 Sw 55th, El Dorado, Portland, OR 97266 | 2014-11-17 |
| 1871930685 | Felicitas Amelia Penaloza | Behavioral Analyst | 9911 Se Mt.scott Boulevard, Portland, OR 97266 | 2013-06-03 |
| 1710237326 | Janna Renee Higgins | Case Manager/Care Coordinator | 9911 Se Mt. Scott Boulevard, Portland, OR 97266 | 2012-09-12 |
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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.