KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (NPI# 1104378140) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104378140 |
| Entity Type | Organization |
| Organization Name | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST |
| Other Organization Name | CLACKAMAS EYE CARE |
| Practice Address |
12100 Se Stevens Ct Suite 106 Portland OR 97086-4707 |
| Mailing Address |
500 Ne Multnomah St Portland OR 97232-2023 |
| Practice Telephone | 8008132000 |
| Practice Fax Number | 5032866879 |
| Mailing Telephone | 5038132000 |
| Mailing Fax Number | 5032866879 |
| Enumeration Date | 2016-10-25 |
| Last Update Date | 2016-10-25 |
| Authorized Official Name | MR. SHAWN BARTON (EXECUTIVE DIRECTOR, REVENUE CYCLE) |
| Authorized Official Telephone | 5038132440 |
| Is Organization Subpart | Y |
| Parent Organization Name | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 152W00000X | Optometrist | Eye and Vision Services Providers | ||
| N | 156F00000X | Technician/Technologist | Eye and Vision Services Providers | ||
| Y | 208D00000X | General Practice | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Clackamas Eye Care | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588153076 | Kaiser Foundation Health Plan of The Northwest | Clinic/Center | 3060 Se Hawthorne Blvd, Portland, OR 97214-4121 | 2018-05-09 |
| 1992242093 | Kaiser Foundation Health Plan of The Northwest | Dentist | 12450 Sw Walker Rd, Beaverton, OR 97005-1401 | 2017-01-26 |
| 1801333901 | Kaiser Foundation Health Plan of The Northwest | General Practice | 3175 Nw Aloclek Dr, Hillsboro, OR 97124-7135 | 2017-01-26 |
| 1790113371 | Kaiser Foundation Health Plan of The Northwest | Pharmacy | 1230 7th Ave., Longview, WA 98682 | 2013-10-17 |
| 1093142234 | Kaiser Foundation Health Plan of The Northwest | Pharmacy | 1700 Ne 102nd Ave., Portland, OR 97220 | 2013-10-02 |
| 1427346543 | Kaiser Foundation Health Plan of The Northwest | Pharmacy | 5381 E Main St, Hillsboro, OR 97123-6447 | 2011-07-11 |
| 1215976014 | Kaiser Foundation Health Plan of The Northwest | Pharmacy | 5717 Ne 138th Ave, Portland, OR 97230-3409 | 2006-06-06 |
| 1801834510 | Kaiser Foundation Health Plan of The Northwest | Pharmacy | 2400 Lancaster Dr Ne, Salem, OR 97305-1221 | 2006-06-03 |
| 1568418051 | Kaiser Foundation Health Plan of The Northwest | Pharmacy | 7705 Se Division St, Portland, OR 97206-1059 | 2006-05-26 |
| 1962456194 | Kaiser Foundation Health Plan of The Northwest | Pharmacy | 5725 Ne 138th Ave, Portland, OR 97230-3409 | 2006-05-20 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | One Kaiser Plaza, Oakland, CA 94612 |
| Washington State Corporations | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | One Kaiser Plaza, Oakland, CA 94612 |
| Street Address |
12100 SE STEVENS CT SUITE 106 |
| City | PORTLAND |
| State | OR |
| Zip Code | 97086-4707 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124003397 | Molly Sue Cardenal | Optometrist | 12100 Se Stevens Ct, Ste 106, Portland, OR 97266-7266 | 2005-12-10 |
| 1669567780 | Edward Nicholas Mulder | Optometrist | 12100 Se Stevens Ct, Ste. 106, Portland, OR 97086-4707 | 2006-10-04 |
| 1811081243 | David Neil Campagna | Optometrist | 12100 Se Stevens Ct, Suite 106, Portland, OR 97266-8707 | 2006-10-02 |
| 1124110010 | Dannica Joanne Hawes | Technician/Technologist | 12100 Se Stevens Ct, Suite 106, Portland, OR 97266-8707 | 2006-09-28 |
| 1588768501 | Michele Marie Hall | Optometrist | 12100 Se Stevens Ct, Ste 106, Portland, OR 97266-8707 | 2006-09-11 |
| 1063529311 | Anne Marie Mattson | Optometrist | 12100 Se Stevens Ct, Suite 106, Portland, OR 97266-8707 | 2006-08-24 |
| 1093821613 | Zakary Scott Hoffelt | Ophthalmology | 12100 Se Stevens Ct, Suite 106, Portland, OR 97206 | 2006-08-23 |
| 1932215621 | Julianna Marie Flores | Technician/Technologist | 12100 Se Stevens Ct, Ste 106, Portland, OR 97266-8707 | 2006-08-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063803674 | Brandy Lynn Sajovic | Case Manager/Care Coordinator | 10822 Se 82nd Ave., Suite K, Happy Valley, OR 97086 | 2015-02-18 |
| 1851795561 | Tyler Lundquist | Chiropractor | 16144 Se Happy Valley Town Center Dr #214, Happy Valley, OR 97086 | 2014-10-09 |
| 1184040644 | Rui O'reilly | Massage Therapist | 10911 Se Alyssa Dr, Happy Valley, OR 97086 | 2014-03-07 |
| 1083036990 | Laura Dillard | Registered Nurse | 10822 Se 82nd Ave, Happy Valley, OR 97086 | 2014-01-11 |
| 1699027672 | Clackamas Town Dental, LLC | Dentist | 9225 Se Sunnyside Road, Clackamas, OR 97086 | 2012-10-15 |
| 1750639233 | Northland Hearing Centers, Inc. | Hearing Instrument Specialist | 11800 Se 82nd Avenue, Happy Valley, OR 97086 | 2012-08-15 |
| 1962641654 | Mt Scott Vision and Ocular Imaging Center PC | Optometrist | 9300 Ne 91st Ave, Suite 100, Happy Valley, OR 97086 | 2009-02-19 |
| 1598916546 | Cynthia Sue Weaver | Nurse Practitioner | 9300 Se 91 Ave., Suite 400, Portland, OR 97086 | 2008-10-08 |
| 1396928776 | Cary Ann Fardal | Dietitian, Registered | 13444 Se Piper Dr, Happy Valley, OR 97086 | 2007-12-09 |
| 1689873242 | New Seasons Market - Happy Valley | Pharmacy | 15861 Se Happy Valley Town Center Dr., Happy Valley, OR 97086 | 2007-07-13 |
| Find all providers in zip 97086 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194223107 | Landmark Connect of Oregon PC | General Practice | 5933 Ne Win Sivers Dr Ste 310, Portland, OR 97220 | 2018-01-24 |
| 1346751443 | Providence Health & Services Oregon | General Practice | 4400 Ne Halsey St, Pop 2, 3rd Floor, Portland, OR 97213-1545 | 2017-10-16 |
| 1336697143 | Rita Lawler | General Practice | 8353 Se Clatsop Ct, Portland, OR 97266-6159 | 2016-09-21 |
| 1235526849 | Hollis Lule Augee | General Practice | 5151 S.w. 88th Ave., Portland, OR 97225-1717 | 2015-04-21 |
| 1093134496 | Red Leaf Natural Health Clinic | General Practice | 833 Sw 11th Ave Ste 1018, Portland, OR 97205-2124 | 2014-04-14 |
| 1861770190 | Jeffrey Owen Pentecost | General Practice | 3574 Se Harold Ct, Portland, OR 97202-4344 | 2011-08-03 |
| 1255651592 | Nic Group Inc | General Practice | 8383 Ne Sandy Blvd Ste 320dd, Portland, OR 97220-4968 | 2010-06-09 |
| 1619296985 | Thcf | General Practice | 105 Se 18th Ave, Portland, OR 97214-1559 | 2010-05-25 |
| 1518106640 | Keith C Klopfer | General Practice | 1601 Sw Pendleton St, Portland, OR 97239-2619 | 2009-02-12 |
| 1275793424 | Harriet Cooke | General Practice | 2929 Sw Multnomah Blvd Ste 301, Portland, OR 97219-4072 | 2008-06-11 |
| Find all providers in PORTLAND | ||||
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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.