BRYAN JOSEPH INGRAM (NPI# 1164784526) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164784526 |
| Entity Type | Individual |
| Full Name | BRYAN JOSEPH INGRAM |
| Practice Address |
6003 Se 136th Ave Portland OR 97236-4567 |
| Mailing Address |
Po Box 8459 Portland OR 97207-8459 |
| Practice Telephone | 5039542119 |
| Mailing Telephone | 5032380769 |
| Enumeration Date | 2012-06-12 |
| Last Update Date | 2012-06-12 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 372600000X | Adult Companion | Nursing Service Related Providers |
| Street Address |
6003 SE 136TH AVE |
| City | PORTLAND |
| State | OR |
| Zip Code | 97236-4567 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205053600 | St. Jude Operating Company, LLC | Nursing Facility/Intermediate Care Facility | 6003 Se 136th Ave, Portland, OR 97236-4567 | 2007-04-19 |
| 1962025809 | Sapphire At Cedar Crossings, LLC | Skilled Nursing Facility | 6003 Se 136th Ave, Portland, OR 97236-4567 | 2020-05-27 |
| 1568008654 | Jennifer Blair | Counselor | 6003 Se 136th Ave, Portland, OR 97236-4567 | 2019-11-23 |
| 1982254579 | Miranda Boyte | Occupational Therapy Assistant | 6003 Se 136th Ave, Portland, OR 97236-4567 | 2019-09-16 |
| 1982179644 | Abhinaya Srinivasan | Speech-Language Pathologist | 6003 Se 136th Ave, Portland, OR 97236-4567 | 2018-10-09 |
| 1457765612 | Camelia Mayfield | Case Manager/Care Coordinator | 6003 Se 136th Ave, Portland, OR 97236-4567 | 2014-06-16 |
| 1538598206 | Jacqueline Bitner | Case Manager/Care Coordinator | 6003 Se 136th Ave, Portland, OR 97236-4567 | 2013-11-04 |
| 1164864930 | Diana Gates | Counselor | 6003 Se 136th Ave, Portland, OR 97236-4567 | 2013-07-22 |
| 1952667669 | Foster Creek Operating Company, LLC | Nursing Facility/Intermediate Care Facility | 6003 Se 136th Ave, Portland, OR 97236-4567 | 2012-04-06 |
| 1760757579 | Sarah Nicole Dowdy | Case Manager/Care Coordinator | 6003 Se 136th Ave, Portland, OR 97236-4567 | 2012-03-12 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336650357 | Wondmimu Edao Chako | Registered Nurse | 3708 Se 144th Avenue, Portland, OR 97236 | 2017-10-17 |
| 1881142388 | John Ho | Pharmacist | 14700 Se Division St., Portland, OR 97236 | 2016-09-14 |
| 1306392527 | Lori-ann Lima | Nurse Practitioner | Multnomah County Health Department- Mid Cty Health Ctr, 12710 Se Division St, Portland, OR 97236 | 2016-08-28 |
| 1982096202 | Allan Fitzpatrick Beals-gibson | Adult Companion | 15602 Se Division St., Portland, OR 97236 | 2015-02-24 |
| 1386047132 | Columbiacare Services | Community Based Residential Treatment Facility, Mental Illness | 3530 Se 136th Ave. #5, Portland, OR 97236 | 2014-10-07 |
| 1356750319 | Kendra Harding | Counselor | 17214 Se Division Street, Portland, OR 97236 | 2014-08-04 |
| 1659790400 | Nghia Tran | Pharmacist | 8438 Se 138th Dr, Portland, OR 97236 | 2014-04-09 |
| 1942623764 | Laurel Katherine Hallock Koppelman | Nurse Practitioner | 12720 Se Division Street, Portland, OR 97236 | 2014-01-30 |
| 1982046249 | Victoria D Lathrop | Massage Therapist | 17221 Se Divistion St S-21, Portland, OR 97236 | 2013-07-26 |
| 1669819694 | Ariann Von Vaughn | Dental Hygienist | 18011 Se Pershing Ct, Portland, OR 97236 | 2013-05-31 |
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| Taxonomy Code | 372600000X |
| Grouping | Nursing Service Related Providers |
| Classification | Adult Companion |
| An individual who provides supervision, socialization, and non-medical care to a functionally impaired adult. Companions may assist or supervise the individual with such tasks as meal preparation, laundry and shopping, but do not perform these activities as discrete services. These services are provided in accordance with a therapeutic goal in the plan of care. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184271462 | Taylor Salter | Adult Companion | 7018 N Armour St, Portland, OR 97203-6132 | 2019-08-21 |
| 1235785429 | Lonzall Tatum | Adult Companion | 1212 Sw Clay St Apt 409, Portland, OR 97201-7822 | 2019-08-13 |
| 1205303021 | Imani Anderson | Adult Companion | 434 Ne Roselawn St, Portland, OR 97211-3826 | 2018-10-30 |
| 1568901858 | Christopher Gabriel Lyons | Adult Companion | 1343 Ne 118 Ave. Apt5, Portland, OR 97220 | 2017-02-20 |
| 1104364900 | Rosanna Hunnicutt | Adult Companion | 2601 Se 160th Ave, Portland, OR 97236-2092 | 2017-02-01 |
| 1043755028 | Raolat Ajibade IIi | Adult Companion | 847 N.e 19thave, Portland, OR 97232 | 2016-12-29 |
| 1164972675 | Rachael Anderson | Adult Companion | 423 Ne 160th Ave #11, Portland, OR 97230 | 2016-10-07 |
| 1255789731 | Sherri Schroeder | Adult Companion | 847 Ne 19th Ave., Suite100, Portland, OR 97232 | 2016-05-25 |
| 1750740577 | Sheila Amoo | Adult Companion | 236 N Killingworth St. Apt.b104, Portland, OR 97217 | 2016-02-22 |
| 1609241371 | Denise Broom | Adult Companion | 25 Ne Stafford St, Portland, OR 97211-2241 | 2015-12-07 |
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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.