ILLUMINATION ROCK INTEGRATIVE MEDICINE, LLC
NPI 1356905855
Clinic/Center in Portland, OR
NPI Status: Active since April 30, 2019
Contact Information
4035 SE 52ND AVE STE B
PORTLAND, OR
ZIP 97206
Phone: (503) 482-7556
Fax: (971) 244-9171
- Organization
- Clinic/Center
- Accepts Insurance
About ILLUMINATION ROCK INTEGRATIVE MEDICINE, LLC
This page provides the complete NPI Profile along with additional information for Illumination Rock Integrative Medicine, Llc, a provider established in Portland, Oregon operating as a Clinic/center. The healthcare provider is registered in the NPI registry with number 1356905855 assigned on April 2019. The practitioner's primary taxonomy code is 261Q00000X. The provider is registered as an organization and their NPI record was last updated 4 years ago. Illumination Rock Integrative Medicine, Llc operates as a Multi-Specialty Group with one or more individual practitioners, who practice different areas of specialization. The authorized official of this NPI record is Kirsten Karen Isakson Lac (Managing Member)
- NPI
- 1356905855
- Provider Name
- ILLUMINATION ROCK INTEGRATIVE MEDICINE, LLC
- Entity Type
- Organization
- Location Address
- 4035 SE 52ND AVE STE B PORTLAND, OR 97206
- Location Phone
- (503) 482-7556
- Location Fax
- (971) 244-9171
- Mailing Address
- 4035 SE 52ND AVE STE B PORTLAND, OR 97206
- Mailing Phone
- (971) 229-2140
- Mailing Fax
- (971) 244-9171
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 04-30-2019
- Last Update Date
- 03-30-2022
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Clinic/Center
- Taxonomy Code
- 261Q00000X
- Type
- Ambulatory Health Care Facilities
- Taxonomy Description
- A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 171100000X | Other Service Providers | Acupuncturist | |
| 2 | 175F00000X | Other Service Providers | Naturopath | |
| 3 | 2081N0008X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | |
| 4 | 2081P2900X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | |
| 5 | 225700000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
Group Taxonomy 193200000X MULTI-SPECIALTY GROUP
This provider is a business group of one or more individual practitioners, who practice with different areas of specialization.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- BridgeSpan Standard Bronze Plan - EPO
- BridgeSpan Standard Gold Plan - EPO
- BridgeSpan Standard Silver Plan - EPO
- Moda Health Affinity Bronze 8000 - EPO
- Moda Health Affinity Bronze 9000 - EPO
- Moda Health Affinity Bronze HDHP 7500 - EPO
- Moda Health Affinity Gold 1000 - EPO
- Moda Health Affinity Gold 1500 - EPO
- Moda Health Affinity Gold 250 - EPO
- Moda Health Affinity Silver 3000 - EPO
- Moda Health Affinity Silver 3400 - EPO
- Moda Health Affinity Silver 4500 - EPO
- Moda Health Affinity Silver 6000 - EPO
- Moda Health Oregon Standard Bronze Affinity - EPO
- Moda Health Oregon Standard Gold Affinity - EPO
- Moda Health Oregon Standard Silver Affinity - EPO
- Bronze 8000 Individual Connect - EPO
- Bronze Essential 9000 With 4 Copay No Deductible Office Visits Individual Connect - EPO
- Bronze HSA 7000 Individual Connect - EPO
- Gold 2300 Individual Connect - EPO
- Regence Standard Bronze Plan Individual Connect - EPO
- Regence Standard Gold Plan Individual Connect - EPO
- Regence Standard Silver Plan Individual Connect - EPO
- Silver 6500 Individual Connect - EPO
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 500703138 | MEDICAID (05) | OR | |
| 1932568458 | OTHER (01) | NPI TYPE 1 |
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1356905855, we treat the final digit (5) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 55. The final step is to find the difference between that total and the next multiple of ten (60 - 55 = 5).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 55 is 60. The difference is the calculated check digit.
Other Providers at the Same Location
The following 7 providers are registered at the same or a nearby location.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1356905855, enumerated as an "organization" on April 30, 2019.
The provider is located at 4035 SE 52ND AVE STE B PORTLAND, OR 97206 and the phone number is (503) 482-7556.
Clinic/Center with taxonomy code 261Q00000X.
The provider might be accepting Accepts: BridgeSpan Health Company, Moda Health Plan, Inc.,. Please consult your insurance carrier or call the provider to verify.
