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MANDY CLARK
NPI 1316144389
Counselor - Addiction (Substance Use Disorder) in Portland, OR

Active since July 02, 2007PECOS Enrolled
1030 NE COUCH ST., PORTLAND, OR 97232(503) 239-8400(503) 239-8407 Get Directions Write a Review

NPPES record last updated: February 20, 2015. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Mandy Clark NPPES

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

MANDY CLARK (NPI 1316144389) is an individual addiction (substance use disorder) provider in Portland, Oregon and active in the NPI registry since July 2007. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1316144389
Entity TypeIndividualFemale
Primary Taxonomy101YA0400X
Provider Legal NameMANDY CLARK
Location Address1030 NE COUCH ST.Portland, OR 97232
Mailing Address1027 E. Burnside St.Portland, OR 97214 · (503) 239-8400 · Fax (503) 269-8407
Phone(503) 239-8400
Fax(503) 239-8407
Sole ProprietorNo
Enumeration DateJuly 2, 2007
Last NPPES UpdateFebruary 20, 2015
✔ NPI 1316144389 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyCounselor · Addiction (Substance Use Disorder)Behavioral Health & Social Service Providers
Taxonomy Code101YA0400X
Also ListedCounselor · Mental HealthTaxonomy 101YM0800X
1030 NE COUCH ST., Portland, OR 97232
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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mandy Clark is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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 Mandy Clark reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Multnomah County
1.0 mi
Public Health, State or Local
209 SW 4TH AVE
Portland, OR 97204
  • Reassigned Medicare billing, Oregon enrollment
  • 215 clinicians in this Medicare group
NPI 1417357443 (503) 445-7699

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 15

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

DOROTHY L. GREEN MSW
Counselor (Addiction (Substance Use Disorder))
1030 NE COUCH ST.
PORTLAND, OR 97232
Multnomah County (503) 239-8400
DANNY HARMON LPN
Licensed Practical Nurse
1030 NE COUCH ST.
PORTLAND, OR 97232
Multnomah County (503) 239-8400
MR. THOMAS EVERETTE IMIG C.D.P.
Community Health Worker
1030 NE COUCH ST.
PORTLAND, OR 97232
Multnomah County (503) 239-8400
MRS. VERLENE ROSE BAKER
Specialist/Technologist, Pathology
1030 NE COUCH ST.
PORTLAND, OR 97232
Multnomah County (503) 239-8400
JEFFREY OTTENBACHER RN
Registered Nurse (Addiction (Substance Use Disorder))
1030 NE COUCH ST.
PORTLAND, OR 97232
Multnomah County (503) 239-8400
MS. KATE ANNE CHESNEY CADC I
Counselor (Addiction (Substance Use Disorder))
1030 NE COUCH ST.
PORTLAND, OR 97232
Multnomah County (503) 239-8400
KALEN WALKINGTON RN
Registered Nurse (Addiction (Substance Use Disorder))
1030 NE COUCH ST.
PORTLAND, OR 97232
Multnomah County (503) 239-8400
MRS. SARAH EVE PUSKARITS RN
Registered Nurse (Addiction (Substance Use Disorder))
1030 NE COUCH ST.
PORTLAND, OR 97232
Multnomah County (503) 239-8400

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 Mandy Clark's NPI number?

The NPI number for Mandy Clark is 1316144389. It was assigned to this individual provider in the NPPES registry on July 2, 2007.

Where is Mandy Clark located?

Mandy Clark practices at 1030 NE Couch St., Portland, OR 97232. The listed phone number is (503) 239-8400.

What is Mandy Clark's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Addiction (Substance Use Disorder), with taxonomy code 101YA0400X.

Is Mandy Clark enrolled in Medicare?

Yes. Mandy Clark is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Mandy Clark's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Mandy Clark reassigns Medicare benefits to Multnomah County (Portland, 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 Mandy Clark's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Mandy Clark was last updated on February 20, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 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.