4D TREATMENT MENTOR SERVICES — NPI 1023866878 (Licensed & Credentialed Peer Specialist in PORTLAND, OR)

CMS-1500 Box 24J / 33a • NPI

1023866878

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

175T00000X

Licensed & Credentialed Peer Specialist

Box 32 Service Location & ZIP+4

11010 SE DIVISION ST STE 200, PORTLAND, OR, 97266-6400

✓ 9-Digit EDI 837 ZIP+4 (97266-6400)

Practice Phone & Referral Fax

(971) 422-0044

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1023866878 (4D TREATMENT MENTOR SERVICES) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1023866878` (NPI-2 Organization / Facility)
Provider / Legal Name	4D TREATMENT MENTOR SERVICES
Plain-English Specialty	Licensed & Credentialed Peer Specialist NUCC Code: `175T00000X` (Peer Specialist)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	11010 SE DIVISION ST STE 200, PORTLAND, OR, 97266-6400
Practice Telephone / Fax	Tel: (971) 422-0044
Administrative Mailing Address	11010 SE DIVISION ST STE 200, PORTLAND, OR, 97266-6400
Enumeration & Last Sync	Enumerated: 2024-05-07 \| CMS Record Updated: 2024-05-07
Authorized Official	NICHOLAS CRAPSER (Clinical Director)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

11010 SE DIVISION ST STE 200, PORTLAND, OR, 97266-6400

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Plain-English Taxonomy & CMS Crosswalk (175T00000X)

What Does Taxonomy Code 175T00000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 175T00000X translates to:
"Licensed & Credentialed Peer Specialist"

CMS-1500 Medicare Specialty Crosswalk: Standard HIPAA X12N 837P / CMS-1500
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Peer Specialist for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (4D TREATMENT MENTOR SERVICES)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`175T00000X` — Peer Specialist Plain English: Licensed & Credentialed Peer Specialist	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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4D TREATMENT MENTOR SERVICES (NPI #1023866878)