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Jesse N Spain , CADC II, QMHA-I

Counselor - Addiction (Substance Use Disorder) β€’ Gresham, OR

Active NPI 1477911477 Individual Practitioner Male Practitioner
Practice location in NPPES

620 Ne 2nd St
Gresham, OR 970307514

Call 9712743757 Location details and other listings
Medical Disclaimer

This profile restates public CMS/NPPES data; T-MedInfo gives no medical advice — consult a licensed professional, and call 911 for emergencies.

Practice Location & Contact Primary Location

Practice Address

620 Ne 2nd St

Gresham, OR 970307514

Telephone 9712743757
Fax 5039125740
Organization at the Same NPPES Address or Phone
Native American Rehabilitation Assoc Inc Facility NPI 1942747761

Matched by practice address or phone in NPPES. A shared address or phone does not confirm that this clinician works there.

Other Listings in Public Data

NPPES lists 3 distinct additional practice-address records in Portland, OR. See the list

Source: CMS NPPES NPI Registry, practice location records; release date unavailable.

Listings do not confirm current availability, employment or a shared ownership network.

NPI first issued

2016

The year this clinician's National Provider Identifier (NPI) was issued. An NPI is a unique 10-digit ID that US health care providers use for billing.

What this does not show: NPI first issued

NPIs have been issued only since 2005, so this year is not necessarily when the clinician started practicing.

Source: CMS NPPES NPI Registry.

Medicare assignment not listed

CMS data do not show whether this clinician accepts Medicare assignment. This does not mean they do not accept Medicare. Ask the office.

Medicare assignment applies to Original Medicare. It does not tell you whether the clinician is in a Medicare Advantage plan's network, accepts other insurance, or is taking new patients.

Source: CMS Doctors and Clinicians; Medicare.gov, β€œDoes your provider accept Medicare as full payment?”

Guide: What Medicare assignment means

No telehealth indicator

CMS shows this indicator only when recent Medicare claims include telehealth services. The clinician may still offer telehealth; ask the office.

Source: CMS, Telehealth Indicator on Medicare Care Compare (fact sheet, January 2023); CMS Doctors and Clinicians.

Guide: How Medicare covers telehealth

Compared with the same specialty in Gresham and Oregon

81 active clinicians are listed under Counselor - Addiction (Substance Use Disorder) with a practice address in Gresham, OR (4,040 in Oregon).

Addresses are self-reported to NPPES and may be out of date.

Telehealth indicator in Gresham

0% of these 81 clinicians have the CMS telehealth indicator.

0% of these 81 clinicians are listed by CMS as accepting Medicare assignment.

Sources: CMS Doctors and Clinicians, CMS NPPES NPI Registry. Specialty names follow the NUCC Health Care Provider Taxonomy.

Text: T-MedInfo Β· Report an error.

Specialties & License Numbers Reported to NPPES

Counselor - Addiction (Substance Use Disorder) Primary Specialty

NUCC Taxonomy Code: 101YA0400X

License # reported to NPPES OR 17-04-13
Counselor - Addiction (Substance Use Disorder)

NUCC Taxonomy Code: 101YA0400X

License # reported to NPPES OR 15-01-09
Counselor - Mental Health

NUCC Taxonomy Code: 101YM0800X

License # reported to NPPES OR 19-QMHA-I-00297
Counselor - Mental Health

NUCC Taxonomy Code: 101YM0800X

Check License Status with the State Board License numbers are self-reported to NPPES; T-MedInfo does not confirm them against state records. Current status: Oregon Medical Board.
Look Up on State Board Site

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid ID
500700056 (OR)
Medicaid ID
500722603 (OR)

Secondary Practice Locations

1776 Sw Madison St

Portland, OR 972051715

Phone: 5032241044

1631 Sw Columbia St

Portland, OR 972016025

Phone: 5032312641

17645 Nw Saint Helens Rd

Portland, OR 972311729

Phone: 5036211069

Clinicians Sharing This Practice Address or Phone

Clinicians sharing this NPPES address, phone or fax; a shared contact does not mean they work together.

1 listed
Amy Berg , PMHNP

Nurse Practitioner - Psychiatric/Mental Health

NPI 1205204799

Psychiatric-Mental Health Nurse Practitioner

Career & Practice History Timeline

Changes recorded in monthly NPPES data files: addresses, names, credentials, specialties and NPI status

23 Historical Events
πŸ“
Updated Business Mailing Address July 11, 2019

Registered at 12104 SE TIBBETTS ST, PORTLAND, OR 972661049 (Tel: 9712125312)

πŸ‘€
Provider Name / Credentials Updated March 14, 2019

Recorded as JESSE SPAIN, CADC II/QMHA-I

πŸŽ“
Medical Taxonomy / Specialty Registered (Primary Specialty) March 14, 2019

Counselor (license number reported to NPPES: OR 17-04-13)

πŸŽ“
Medical Taxonomy / Specialty Registered (Primary Specialty) March 17, 2018

Counselor (license number reported to NPPES: OR 15-01-09)

βœ…
NPI Profile Active September 14, 2017

NPI status registered as active in NPPES database

πŸ“
Updated Practice Location September 14, 2017

Registered at 620 NE 2ND ST, GRESHAM, OR 970307514 (Tel: 9712743757)

πŸ“
Updated Business Mailing Address September 14, 2017

Registered at 1776 SW MADISON ST, PORTLAND, OR 972051715 (Tel: (971) 386-2278)

πŸ‘€
Provider Name / Credentials Updated September 14, 2017

Recorded as JESSE SPAIN, CADC II/QMHA

πŸŽ“
Medical Taxonomy / Specialty Registered (Primary Specialty) September 14, 2017

Counselor (license number reported to NPPES: OR 17-04-13)

πŸ“
Updated Practice Location July 18, 2017

Registered at 620 NE 2ND ST, GRESHAM, OR 970307514 (Tel: 5032241044)

πŸ‘€
Provider Name / Credentials Updated July 18, 2017

Recorded as JESSE SPAIN, CADC II/QMHA

πŸŽ“
Medical Taxonomy / Specialty Registered (Primary Specialty) July 18, 2017

Counselor (license number reported to NPPES: OR 15-01-09)

πŸ‘€
Provider Name / Credentials Updated March 20, 2017

Recorded as JESSE SPAIN, CADC I/QMHA

πŸŽ“
Medical Taxonomy / Specialty Registered (Primary Specialty) March 20, 2017

Counselor

πŸ“
Updated Business Mailing Address March 01, 2017

Registered at 1776 SW MADISON ST, PORTLAND, OR 972051715 (Tel: 9713862278)

πŸ‘€
Provider Name / Credentials Updated March 01, 2017

Recorded as JESSE SPAIN, CADC I

πŸŽ“
Medical Taxonomy / Specialty Registered (Primary Specialty) March 01, 2017

Counselor (license number reported to NPPES: OR 15-01-09)

βœ…
NPI Profile Active February 04, 2016

NPI status registered as active in NPPES database

πŸ“
Practice Location (Initial Record) February 04, 2016

Registered at 17645 NW SAINT HELENS RD, PORTLAND, OR 972311729 (Tel: 5036211069)

πŸ“
Business Mailing Address (Initial Record) February 04, 2016

Registered at 12104 SE TIBBETTS ST, PORTLAND, OR 972661049

πŸ‘€
Provider Name / Credentials (Initial Record) February 04, 2016

Recorded as JESSE SPAIN, CADC1

πŸŽ“
Medical Taxonomy / Specialty Registered (Primary Specialty) February 04, 2016

Contractor (license number reported to NPPES: OR 15-01-09)

🟒
Initial NPI Registration & Enumeration February 04, 2016

First registered as active Individual Practitioner in NPPES Database.

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NPI Administrative Meta

NPI Number: 1477911477
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: February 04, 2016
Last Update: July 11, 2019
Sole Proprietor: No

Mailing Address

12104 Se Tibbetts St

Portland, OR 972661049

Phone: 9712125312

About This Data NPPES fields (address, phone, specialty, license) are self-reported and may be outdated; Medicare fields follow the CMS dataset named in each section. Correct directly at NPPES.