POLK COUNTY ALCOHOL AND DRUG – Addiction (Substance Use Disorder) Counselor, NPI 1720013071
Addiction (Substance Use Disorder) Counselor
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for POLK COUNTY ALCOHOL AND DRUG
182, Southwest Academy Street, Dallas City Limits, Polk County, Oregon, 97338, United States
SUITE #310 POLK COUNTY ALCOHOL AND DRUG
DALLAS, OR 973381922
Phone: (503) 623-9317
Fax: (503) 623-2731
Type: Mailing
182, Southwest Academy Street, Dallas, Polk County, Oregon, 97338, United States
SUITE #304
DALLAS, OR 973381922
Phone: (503) 623-9289
Fax: (503) 831-1726
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
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Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20040405001567 | O | Clinic/Group Practice | OR | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 97338)
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