Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1790133031 Individual Practitioner Female Practitioner

Modupe Desiree Bansile

Peer Specialist • Portland, OR

Professional Overview & Biography Verified Profile Summary

Modupe Bansile is a registered healthcare professional specializing in Peer Specialist in Portland, OR. Practice services are available at 209 SW FOURTH AVE, SUITE 520 under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

209 Sw Fourth Ave, Suite 520

Portland, OR 97204

Telephone 5415569195

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 THW2156

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

NUCC Taxonomy Code: 101Y00000X

A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master's degree and clinical experience and supervision for licensure or certification.

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID
THW2156 (OR)

Secondary Practice Locations

707 Ne Couch St

Portland, OR 972322922

Phone: 5035424603

445 Port Ave

Saint Helens, OR 970516225

Phone: 5415569195

209 Sw Fourth Ave, Suite 520

Portland, OR 97204

Phone: 5415569195

Career & Practice History Timeline

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

13 Historical Events
📍
Updated Practice Location October 30, 2018

Registered at 209 SW FOURTH AVE, SUITE 520, PORTLAND, OR 97204 (Tel: 5415569195)

📍
Updated Business Mailing Address October 30, 2018

Registered at 11073 SE MAIN ST, MILWAUKIE, OR 97222 (Tel: 5415569195)

NPI Profile Active January 04, 2018

NPI status registered as active in NPPES database

📍
Updated Practice Location January 04, 2018

Registered at 445 PORT AVE, SAINT HELENS, OR 970516225 (Tel: 5415569195)

📍
Updated Business Mailing Address January 04, 2018

Registered at 445 PORT AVE, SAINT HELENS, OR 970516225 (Tel: 5415569195)

👤
Provider Name / Credentials Updated January 04, 2018

Recorded as MODUPE BANSILE

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) January 04, 2018

Counselor

NPI Profile Active May 26, 2016

NPI status registered as active in NPPES database

📍
Updated Practice Location May 26, 2016

Registered at 707 NE COUCH ST, PORTLAND, OR 972322922 (Tel: 5035424603)

📍
Updated Business Mailing Address May 26, 2016

Registered at 7640 N CURTIS AVE, PORTLAND, OR 972176106 (Tel: 8147693193)

👤
Provider Name / Credentials Updated May 26, 2016

Recorded as MODUPE BANSILE

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) May 26, 2016

Counselor

🟢
Initial NPI Registration & Enumeration May 26, 2016

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: 1790133031
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: May 26, 2016
Last Update: October 30, 2018
Sole Proprietor: Yes

Mailing Address

11073 Se Main St

Milwaukie, OR 97222

Phone: 5415569195

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.