PORTLAND ADVENTIST MEDICAL CENTER (NPI# 1023583994) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023583994 |
| Entity Type | Organization |
| Organization Name | PORTLAND ADVENTIST MEDICAL CENTER |
| Other Organization Name | ADVENTIST HEALTH PORTLAND - CLACKAMAS |
| Practice Address |
11211 Se Sunnyside Rd Clackamas OR 97015-7787 |
| Mailing Address |
Po Box 92900 Portland OR 97292-0900 |
| Practice Telephone | 5036590880 |
| Practice Fax Number | 5035137425 |
| Mailing Telephone | 5032616085 |
| Enumeration Date | 2018-10-08 |
| Last Update Date | 2020-01-08 |
| Authorized Official Name | JOYCE NEWMYER (CEO) |
| Authorized Official Telephone | 5032516150 |
| Is Organization Subpart | Y |
| Parent Organization Name | PORTLAND ADVENTIST MEDICAL CENTER |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians | ||
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Adventist Health Portland - Clackamas | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194147074 | Portland Adventist Medical Center | Internal Medicine | 10201 Se Main St Ste 12, Portland, OR 97216-2937 | 2014-01-13 |
| 1861475642 | Portland Adventist Medical Center | Home Health | 1015 3rd St, Tillamook, OR 97141-8292 | 2005-11-25 |
| 1396727848 | Portland Adventist Medical Center | Home Health | 5835 Ne 122nd Ave, Building A; Suite #155, Portland, OR 97230-1057 | 2005-11-18 |
| 1801887658 | Portland Adventist Medical Center | General Acute Care Hospital | 10123 Se Market St, Portland, OR 97216 | 2005-11-01 |
| 1538709498 | Portland Adventist Medical Center | Internal Medicine | 1350 Ne 122nd Ave, Portland, OR 97230-2011 | 2020-01-08 |
| 1619517588 | Portland Adventist Medical Center | Family Medicine | 1700 Sw 257th Ave, Troutdale, OR 97060-1900 | 2020-01-08 |
| 1558901413 | Portland Adventist Medical Center | Family Medicine | 19220 Mcloughlin Blvd, Gladstone, OR 97027-2642 | 2020-01-08 |
| 1316502719 | Portland Adventist Medical Center | Emergency Medicine | 10123 Se Market St, Portland, OR 97216-2532 | 2019-05-01 |
| 1972078590 | Portland Adventist Medical Center | Internal Medicine | 831 Nw Council Dr Ste 125, Gresham, OR 97030-3794 | 2018-10-10 |
| 1881169407 | Portland Adventist Medical Center | Family Medicine | 17055 Ruben Ln, Sandy, OR 97055-9276 | 2018-10-10 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | PORTLAND ADVENTIST MEDICAL CENTER | 10123 Se Market St, Portland, OR 97216-2532 |
| Oregon Corporations, Companies and Business Names | PORTLAND ADVENTIST MEDICAL CENTER | 10123 Se Market St, Portland, OR 97216 |
| Street Address |
11211 SE SUNNYSIDE RD |
| City | CLACKAMAS |
| State | OR |
| Zip Code | 97015-7787 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194789453 | Larry L Moffett | Family Medicine | 11211 Se Sunnyside Rd, Clackamas, OR 97015-7787 | 2006-04-13 |
| 1679994610 | Leslie Clements | Social Worker | 11211 Se Sunnyside Rd, Clackamas, OR 97015-7787 | 2013-12-18 |
| 1205270915 | Ashley Spears | Social Worker | 11211 Se Sunnyside Rd, Clackamas, OR 97015-7787 | 2013-04-24 |
| 1609150036 | Jennifer Andreson | Nurse Practitioner | 11211 Se Sunnyside Rd, Clackamas, OR 97015-7787 | 2011-10-04 |
| 1750610192 | Teresa Renee Field | Marriage & Family Therapist | 11211 Se Sunnyside Rd, Clackamas, OR 97015-7787 | 2009-12-14 |
| 1073720017 | Chaise Group, LLC | Social Worker | 11211 Se Sunnyside Rd, Clackamas, OR 97015-7787 | 2007-05-17 |
| 1124033618 | Michelle L Krummenacker | Counselor | 11211 Se Sunnyside Rd, Clackamas, OR 97015-6739 | 2006-07-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184103517 | Laurel Perilli | Physical Therapist | 12550 Se 93rd Ave Ste 265, Clackamas, OR 97015 | 2018-08-07 |
| 1306324538 | Kristin Connor Messing | Physical Therapist | 4805 Ne Glisan St, Prov Hall 7e06, Portland, OR 97015 | 2018-07-31 |
| 1902317266 | Darcy Jones Hamrick | Counselor | 12901 Se 97th Ave., Suite 340, Clackamas, OR 97015 | 2017-10-13 |
| 1841723384 | Manon Lavoie | Chiropractor | 17105 Se Sunnyside Rd, Suite 148, Happy Valley, OR 97015 | 2017-04-11 |
| 1235670126 | Michael G Short | Pedorthist | 10117 Se Sunnyside Rd., Ste. H, Clackamas, OR 97015 | 2017-03-13 |
| 1487100756 | Michael Joseph Peizner | Pharmacist | 16300se Evelyn Street, Clackamas, OR 97015 | 2016-08-28 |
| 1316395619 | Jennifer Elaine Walkowski | Physical Therapist | 9100 Se Sunnyside Road, Clackamas, OR 97015 | 2016-05-26 |
| 1649635384 | Brookside Dental - Milwaukie, LLC | Dentist | 9225 Se Sunnyside Rd. Ste 1, Clackamas, OR 97015 | 2015-12-23 |
| 1801216130 | Robert D. Grew Dmd, Inc. | Dentist | 10163 Se Sunnyside Road, Suite 414, Clackamas, OR 97015 | 2014-04-25 |
| 1508205410 | Valerie P Tabalno | Massage Therapist | 15661 Se 82nd Dr, Clackamas, OR 97015 | 2013-06-25 |
| Find all providers in zip 97015 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386242790 | Rose City Medical Clinic LLC | Family Medicine | 11397 Se Cascade View Ct, Clackamas, OR 97086-9753 | 2020-10-16 |
| 1447428925 | Cheryl B. Hickethier, PC | Family Medicine | 14831 Se 82nd Dr, Clackamas, OR 97015-7624 | 2008-02-18 |
| 1801973664 | Karen Ann Kuryla | Family Medicine | 9775 Se Sunnyside Rd Ste 200, Clackamas, OR 97015-5721 | 2006-11-01 |
| 1851404230 | David Bruce Mitchell | Family Medicine | 13636 Se Taralon Dr, Clackamas, OR 97015 | 2006-08-17 |
| 1700840675 | Thomas H Hickerson | Family Medicine | 14450 Se Royer Rd, Clackamas, OR 97015-8730 | 2006-04-17 |
| 1194789453 | Larry L Moffett | Family Medicine | 11211 Se Sunnyside Rd, Clackamas, OR 97015-7787 | 2006-04-13 |
| 1356324842 | Barry N. Davis | Family Medicine | 12360 Se Sunnyside Rd, Clackamas, OR 97015-9320 | 2005-11-29 |
| 1578559951 | Raymond S Lee | Family Medicine | 10151 Se Sunnyside Rd Ste 100, Clackamas, OR 97015-5705 | 2005-09-21 |
| 1841647559 | Ewen J Harrison | Family Medicine | 9290 Se Sunnybrook Blvd Ste 120, Clackamas, OR 97015-6802 | 2016-05-23 |
| 1750777066 | Kevin Do | Family Medicine | 10151 Se Sunnyside Rd Ste 100, Clackamas, OR 97015-5705 | 2015-04-13 |
| Find all providers in CLACKAMAS | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.