MR. BRADLEY PAUL ROAN EAGLE
NPI 1497393425
Peer Specialist in Baker City, OR
NPI Status: Active since December 20, 2019
- Individual
- Male
- Peer Specialist
About BRADLEY ROAN EAGLE
This page provides the complete NPI Profile along with additional information for Bradley Roan Eagle, a provider established in Baker City, Oregon with a medical specialization in Peer Specialist. The healthcare provider is registered in the NPI registry with number 1497393425 assigned on December 2019. The practitioner's primary taxonomy code is 175T00000X with license number 21-CRM-411 (OR). The provider is registered as an individual and his NPI record was last updated 4 years ago.
- NPI
- 1497393425
- Provider Name
- MR. BRADLEY PAUL ROAN EAGLE
- Gender
- Male
- Entity Type
- Individual
- Location Address
- 3425 13TH ST BAKER CITY, OR 97814
- Location Phone
- (605) 516-0083
- Mailing Address
- 3425 13TH ST BAKER CITY, OR 97814
- Mailing Phone
- (541) 523-7400
- Mailing Fax
- Is Sole Proprietor?
- No
- Enumeration Date
- 12-20-2019
- Last Update Date
- 04-08-2021
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Peer Specialist
- Taxonomy Code
- 175T00000X
- Type
- Other Service Providers
- License No.
- 21-CRM-411
- License State
- OR
- Taxonomy Description
- Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | CADC-RT-20-486 (OR) |
| 2 | 171M00000X | Other Service Providers | Case Manager/Care Coordinator | 20-QMHA-R-0842 (OR) |
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 21-CRM-411 | OTHER (01) | OR | CRM CERTIFICATE - MHACBO |
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NPI Validation Check Digit Calculation
The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.
| Start with the original NPI number, the last digit is the check digit and is not used in the calculation. | |||||||||
| 1 | 4 | 9 | 7 | 3 | 9 | 3 | 4 | 2 | 5 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 4 | 18 | 7 | 6 | 9 | 6 | 4 | 4 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 4 + 1 + 8 + 7 + 6 + 9 + 6 + 4 + 4 + 24 = 75 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 80 - 75 = 5 | 5 | ||||||||
The NPI number 1497393425 is valid because the calculated check digit 5 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following 20 providers are registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1417499013 | MRS. AUBREYANNA M HENSHAW QMHA; CADC-R Individual | Social Worker | 3425 13TH ST BAKER CITY, OR 97814 (541) 523-7400 |
| 1386291672 | SHELLEY DEVORE Individual | Counselor (Mental Health) | 3425 13TH ST BAKER CITY, OR 97814 (541) 523-7400 |
| 1265051726 | MAE LYNN CORWIN Individual | Peer Specialist | 3425 13TH ST BAKER CITY, OR 97814 (541) 523-7400 |
| 1841630746 | ANDRIA WEBER Individual | Counselor (Addiction (Substance Use Disorder)) | 3425 13TH ST BAKER CITY, OR 97814 (541) 523-7400 |
| 1235124462 | NEW DIRECTIONS NORTHWEST, INC Organization | Clinic/Center | 3425 13TH ST BAKER CITY, OR 97814 (541) 523-4000 |
| 1063009264 | MS. KIMBERLY ANN HAM Individual | Counselor (Addiction (Substance Use Disorder)) | 3425 13TH ST BAKER CITY, OR 97814 (541) 523-7400 |
| 1760061808 | MS. TIFFANY JORDAN BRONSON Individual | Case Manager/Care Coordinator | 3425 13TH ST BAKER CITY, OR 97814 (541) 523-7400 |
| 1457934861 | MS. SKYLAR JADE BLANKENSHIP Individual | Peer Specialist | 3425 13TH ST BAKER CITY, OR 97814 (541) 523-7400 |
| 1003325200 | TED WOODRUFF CRM Individual | Counselor (Addiction (Substance Use Disorder)) | 3425 13TH ST BAKER CITY, OR 97814 (541) 523-7400 |
| 1124669288 | ANDREA MARIE LANNING BSN, RN Individual | Registered Nurse | 3425 13TH ST BAKER CITY, OR 97814 (541) 523-7400 |
| 1295270908 | CASSANDRA R REEDER Individual | Counselor (Mental Health) | 3425 13TH ST BAKER CITY, OR 97814 (541) 523-7400 |
| 1912423229 | DEANA L WALLACE Individual | Counselor (Addiction (Substance Use Disorder)) | 3425 13TH ST BAKER CITY, OR 97814 (541) 523-7400 |
| 1245994979 | BENJAMIN DANIEL CORNELL Individual | Counselor (Mental Health) | 3425 13TH ST BAKER CITY, OR 97814 (541) 523-7400 |
| 1558020628 | TYRAH ROBIAN STEELE Individual | Peer Specialist | 3425 13TH ST BAKER CITY, OR 97814 (541) 523-7400 |
| 1760136972 | VINCE PHILLIP MITCHELL Individual | Counselor (Addiction (Substance Use Disorder)) | 3425 13TH ST BAKER CITY, OR 97814 (541) 523-7400 |
| 1003223694 | COLLEEN BETTILYEN DAVENPORT PMHNP Individual | Nurse Practitioner (Psychiatric/Mental Health) | 3425 13TH ST BAKER CITY, OR 97814 (541) 523-7400 |
| 1417607540 | LUISA REYES SIERRA Individual | Case Manager/Care Coordinator | 3425 13TH ST BAKER CITY, OR 97814 (541) 523-7400 |
| 1760132807 | KYLER DAWN MAYBERRY Individual | Peer Specialist | 3425 13TH ST BAKER CITY, OR 97814 (541) 523-7400 |
| 1093463879 | AMANDA ELISABETH LAMILLER Individual | Peer Specialist | 3425 13TH ST BAKER CITY, OR 97814 (541) 523-7400 |
| 1588153829 | LOIS JEAN GRUSHKA QMHP Individual | Social Worker (Clinical) | 3425 13TH ST BAKER CITY, OR 97814 (541) 523-7400 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1497393425, enumerated in the NPI registry as an "individual" on December 20, 2019
The provider is located at 3425 13th St Baker City, Or 97814 and the phone number is (605) 516-0083
The provider's speciality is Peer Specialist with taxonomy code 175T00000X
The provider might be accepting Accepts: Medicare and Medicaid. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.
This NPI record was last updated on December 20, 2019. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
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