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JEREMY JOHN ARCHIBALD MH INTERN
NPI 1013289578
Counselor - Mental Health in Salem, OR

Active since January 31, 2012PECOS Enrolled
3867 WOLVERINE ST NE BLDG F, SALEM, OR 97305(503) 588-5352 Get Directions Write a Review

NPPES record last updated: June 9, 2022. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Jeremy John Archibald Mh Intern NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JEREMY JOHN ARCHIBALD MH INTERN (NPI 1013289578) is an individual mental health provider in Salem, Oregon and active in the NPI registry since January 2012. He is enrolled in Medicare PECOS and is a graduate of Other (2022).

NPPES Registry Identity

NPI1013289578
Entity TypeIndividualMale
Primary Taxonomy101YM0800X
Provider Legal NameJEREMY JOHN ARCHIBALDCredential: MH INTERN
Location Address3867 WOLVERINE ST NE BLDG FSalem, OR 97305-4266
Mailing Address3867 Wolverine St Ne Bldg FSalem, OR 97305-4266 · (503) 588-5352
Phone(503) 588-5352
Sole ProprietorYes
Medical School CMSOtherGraduated 2022
Enumeration DateJanuary 31, 2012
Last NPPES UpdateJune 9, 2022
NPPES CertifiedJune 9, 2022
✔ NPI 1013289578 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
3867 WOLVERINE ST NE BLDG F, Salem, OR 97305
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BridgeSpan Health Company, Moda Health Plan, Inc., Regence BlueCross BlueShield of Oregon.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jeremy John Archibald Mh Intern is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID143700419
PECOS Enrollment IDI20260216002974
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Jeremy Archibald reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

South Salem Rehabilitation, LLC
5.3 mi
Skilled Nursing Facility
3445 BOONE RD SE
Salem, OR 97317
  • Reassigned Medicare billing, Oregon enrollment
  • Medicare enrollment name: Kaiser Foundation Health Plan Of The Northwest
  • 3,207 clinicians in this Medicare group
NPI 1215071998 (503) 576-3000

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 12

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

AARON ALEXANDER LEVINSON LCSW, DSW, MBA
Social Worker (Clinical)
3867 WOLVERINE ST NE BLDG F
SALEM, OR 97305
Marion County (971) 428-7762
ANGELA ELLER
Counselor (Mental Health)
3867 WOLVERINE ST NE BLDG F
SALEM, OR 97305
Marion County (503) 361-2741
PATRICK ANDRES GARCIA
Counselor (Mental Health)
3867 WOLVERINE ST NE BLDG F
SALEM, OR 97305
Marion County (503) 588-5352
TREVOR OWEN
Counselor (Mental Health)
3867 WOLVERINE ST NE BLDG F
SALEM, OR 97305
Marion County (503) 361-2689
CECILIA SANCHEZ
Counselor (Mental Health)
3867 WOLVERINE ST NE BLDG F
SALEM, OR 97305
Marion County (503) 576-4582
PATRICIA DILLON LPC
Counselor (Professional)
3867 WOLVERINE ST NE BLDG F
SALEM, OR 97305
Marion County (503) 588-5352
HANNAH WHITE
Counselor (Mental Health)
3867 WOLVERINE ST NE BLDG F
SALEM, OR 97305
Marion County (503) 361-2718
HEATHER ISHAM QMHP-R
Counselor
3867 WOLVERINE ST NE BLDG F
SALEM, OR 97305
Marion County (503) 588-5352

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jeremy Archibald's NPI number?

The NPI number for Jeremy Archibald is 1013289578. It was assigned to this individual provider in the NPPES registry on January 31, 2012.

Where is Jeremy Archibald located?

Jeremy Archibald practices at 3867 Wolverine St NE Bldg F, Salem, OR 97305. The listed phone number is (503) 588-5352.

What is Jeremy Archibald's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

Is Jeremy Archibald enrolled in Medicare?

Yes. Jeremy Archibald is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Jeremy Archibald's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Jeremy Archibald reassigns Medicare benefits to South Salem Rehabilitation, LLC (Salem, OR). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Jeremy Archibald's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Jeremy Archibald accept?

Health plans from BridgeSpan Health Company, Moda Health Plan, Inc. and Regence BlueCross BlueShield of Oregon list Jeremy Archibald as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Jeremy Archibald was last updated on June 9, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.