Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1316477441 Individual Practitioner Male Practitioner

Patrick G Eagle Staff , PWS, QMHP-C

Peer Specialist • Portland, OR

Professional Overview & Biography Verified Profile Summary

Patrick Eagle Staff, PWS, QMHP-C is a registered healthcare professional specializing in Peer Specialist in Portland, OR. Practice services are available at 1310 SW 17TH AVE under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

1310 Sw 17th Ave

Portland, OR 972012522

Telephone 5032312641
Fax 5034674077
Associated Practice Facility / Clinic

Specialty Benchmarks & Practice Insights

Comparative analytics for Peer Specialist in Portland, OR

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

Practicing in Portland, 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

Peer Specialist Primary Specialty

NUCC Taxonomy Code: 175T00000X

State License OR THW0002219

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.

Counselor - Mental Health

NUCC Taxonomy Code: 101YM0800X

State License OR 19-QMHPC-00380

Definition to come...

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID
500761421 (OR)
Medicaid State Provider ID
500733968 (OR)

Secondary Practice Locations

620 Ne 2nd St

Gresham, OR 970307514

Phone: 9712743757

1631 Sw Columbia St

Portland, OR 972016025

Phone: 5036212235

Practice Associates & Co-Workers

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

40 Associated Practitioners
Donna Turquoise , QMHP-C

Counselor - Mental Health

NPI 1003103359

QMHPC

Amber Lewis , CRM, PSS

Counselor - Addiction (Substance Use Disorder)

NPI 1003450248
Deanna Shields , CADC-R, CRM, PSS

Counselor - Addiction (Substance Use Disorder)

NPI 1003592759

CADCR, CRM, PSS

Jessica Spain , CADC I, QMHA-R

Counselor - Addiction (Substance Use Disorder)

NPI 1013430271

CADCI, QMHAR

Tara Walker , QMHP, MS

Counselor - Mental Health

NPI 1013471549

Qualified Mental Health Professional, Master of Science

Nicole Williams , CADC II, QMHA-I

Counselor - Mental Health

NPI 1013560713

CADCII, QMHAI

Career & Practice History Timeline

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

20 Historical Events
👤
Provider Name / Credentials Updated May 24, 2019

Recorded as PATRICK EAGLE STAFF, PWS/QMHP-C

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) May 24, 2019

Counselor (License #19-QMHPC-00380 in OR)

📍
Updated Practice Location April 16, 2019

Registered at 1310 SW 17TH AVE, PORTLAND, OR 972012522 (Tel: 5032312641)

👤
Provider Name / Credentials Updated April 16, 2019

Recorded as PATRICK EAGLE STAFF, PWS/QMHA

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) April 16, 2019

Counselor

📍
Updated Practice Location April 03, 2019

Registered at 1631 SW COLUMBIA ST, PORTLAND, OR 972016025 (Tel: 5036212235)

👤
Provider Name / Credentials Updated April 03, 2019

Recorded as PATRICK EAGLE STAFF, PWS/QMHP

NPI Profile Active February 08, 2018

NPI status registered as active in NPPES database

📍
Updated Practice Location February 08, 2018

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

📍
Updated Business Mailing Address February 08, 2018

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

👤
Provider Name / Credentials Updated February 08, 2018

Recorded as PATRICK EAGLE STAFF, PWS

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) February 08, 2018

Counselor (License #THW0002219 in OR)

👤
Provider Name / Credentials Updated October 09, 2017

Recorded as PATRICK EAGLE STAFF, PWS

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) October 09, 2017

Counselor (License #THW0002219 in OR)

NPI Profile Active June 12, 2017

NPI status registered as active in NPPES database

📍
Updated Practice Location June 12, 2017

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

📍
Updated Business Mailing Address June 12, 2017

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

👤
Provider Name / Credentials Updated June 12, 2017

Recorded as PATRICK EAGLE STAFF, PSS

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) June 12, 2017

Peer Specialist

🟢
Initial NPI Registration & Enumeration June 12, 2017

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: 1316477441
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: June 12, 2017
Last Update: May 24, 2019
Sole Proprietor: No

Mailing Address

1776 Sw Madison St

Portland, OR 972051715

Phone: 9713862278

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.