Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1407578891 Individual Practitioner Male Practitioner

Jack White , CRM, THW

Peer Specialist • Coos Bay, OR

Professional Overview & Biography Verified Profile Summary

Jack White, CRM, THW is a registered healthcare professional specializing in Peer Specialist in Coos Bay, OR. Practice services are available at 1741 NEWMARK AVE under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

1741 Newmark Ave

Coos Bay, OR 974204704

Telephone 5418517151

Specialty Benchmarks & Practice Insights

Comparative analytics for Peer Specialist in Coos Bay, OR

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 10.2 Yrs
Regional Practice Density
52 Specialists

Practicing in Coos Bay, OR (3408 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2022-09-13
Peer Specialist Primary Specialty

NUCC Taxonomy Code: 175T00000X

State License OR 22-CRM-1099

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.

Additional State Medicaid & Healthcare Payer Identifiers

Commercial Insurance / Payer ID Thw
THW000107022 (OR)

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

7 Associated Practitioners
Jessica Manske

Peer Specialist

NPI 1023770328
Laicee Eichler , CADCII, QMHAI

Counselor - Addiction (Substance Use Disorder)

NPI 1275047516
Rhonda Rawe

Peer Specialist

NPI 1275263246
Jarrod Olsen , CRM

Peer Specialist

NPI 1285342162
Kelly Jones

Peer Specialist

NPI 1346902657
NPI 1508588112

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events
NPI Profile Active September 13, 2022

NPI status registered as active in NPPES database

📍
Updated Practice Location September 13, 2022

Registered at 1741 NEWMARK AVE, COOS BAY, OR 974204704 (Tel: 5418517151)

📍
Updated Business Mailing Address September 13, 2022

Registered at 155 S EMPIRE BLVD, COOS BAY, OR 974203374 (Tel: 5418517151)

👤
Provider Name / Credentials Updated September 13, 2022

Recorded as JACK WHITE, CRM , THW

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) September 13, 2022

Peer Specialist (License #22-CRM-1099 in OR)

🟢
Initial NPI Registration & Enumeration September 13, 2022

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1407578891
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: September 13, 2022
Last Update: September 13, 2022
Sole Proprietor: No

Mailing Address

155 S Empire Blvd

Coos Bay, OR 974203374

Phone: 5418517151

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.