PROVIDENCE PORTLAND MEDICAL CENTER (NPI# 1134240021) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134240021 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE PORTLAND MEDICAL CENTER |
| Other Organization Name | PROVIDENCE HOSPITALISTS EAST |
| Practice Address |
4805 Ne Glisan St Suite Bg05 Portland OR 97213-2933 |
| Mailing Address |
Po Box 3178 Portland OR 97208-3178 |
| Practice Telephone | 5032152392 |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2007-10-30 |
| Authorized Official Name | WILLIAM OLSON (CHIEF FINANCE OFFICER) |
| Authorized Official Telephone | 5032156241 |
| Is Organization Subpart | Y |
| Parent Organization Name | PROVIDENCE PORTLAND MEDICAL CENTER |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261Q00000X | Clinic/Center | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 286612 | 05 |
| Other Name | Type Code |
|---|---|
| PROVIDENCE HOSPITALISTS EAST | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427258490 | Providence Portland Medical Center | Clinic/Center | 6241 Se Alder St, Portland, OR 97215-1971 | 2007-07-18 |
| 1134355985 | Providence Portland Medical Center | Clinic/Center | 4805 Ne Glisan St, 1st Floor, Portland, OR 97213-2933 | 2009-06-08 |
| 1316199987 | Providence Portland Medical Center | Nurse Practitioner | 4805 Ne Glisan St, Portland, OR 97213-2933 | 2008-10-15 |
| 1891861605 | Providence Portland Medical Center | Clinic/Center | 5050 Ne Hoyt St, Suite 155, Portland, OR 97213-2991 | 2006-11-27 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | PROVIDENCE PORTLAND MEDICAL CENTER | 4805 Ne Glisan St, Portland, OR 97213-2933 |
| Oregon Corporations, Companies and Business Names | PROVIDENCE PORTLAND MEDICAL CENTER | 4805 Ne Glisan St, Portland, OR 97213 |
| Street Address |
4805 NE GLISAN ST SUITE BG05 |
| City | PORTLAND |
| State | OR |
| Zip Code | 97213-2933 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255337572 | John F Zurasky | Psychiatry & Neurology | 4805 Ne Glisan St, Ste 3g37, Portland, OR 97213-2933 | 2005-06-22 |
| 1083228175 | Alysia M Paaluhi | Registered Nurse | 4805 Ne Glisan St, Portland, OR 97213-2933 | 2020-09-04 |
| 1619595964 | Kathleen Hahn | Dietitian, Registered | 4805 Ne Glisan St, Portland, OR 97213-2933 | 2020-07-13 |
| 1841839107 | Daniel Dean Rosema | Nurse Practitioner | 4805 Ne Glisan St, Portland, OR 97213-2933 | 2020-01-03 |
| 1588207666 | Jean Hannon Mullins-padgett | Nurse Practitioner | 4805 Ne Glisan St, Portland, OR 97213-2933 | 2019-10-22 |
| 1043853146 | Miranda Meyer | Dietitian, Registered | 4805 Ne Glisan St, Portland, OR 97213-2933 | 2019-10-21 |
| 1083260830 | Becky L Bowler | Nurse Practitioner | 4805 Ne Glisan St, Portland, OR 97213-2933 | 2019-08-16 |
| 1366096406 | Nicole W Engel | Registered Nurse | 4805 Ne Glisan St, Portland, OR 97213-2933 | 2019-07-26 |
| 1558924753 | Susan Lien | Nurse Practitioner | 4805 Ne Glisan St, Portland, OR 97213-2933 | 2019-04-15 |
| 1356809644 | Katheryne Zempel | Physical Therapist | 4805 Ne Glisan St, Portland, OR 97213-2933 | 2019-03-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831715176 | Darnell Jackie Strong | Social Worker | 435 Ne 78th Ave 'strong Counseling Services', Portland, OR 97213 | 2020-06-23 |
| 1336775907 | Redpoint Physical Therapy and Performance LLC | Physical Therapist | 4200 Ne Flanders St Unit B, Portland, OR 97213 | 2020-03-16 |
| 1801431218 | Denise Dorgan-miller | Occupational Therapy Assistant | Providence Elder Place, 4400 Ne Halsey Suite 200, Portland, OR 97213 | 2019-11-08 |
| 1619435617 | Aspiration of Character Counseling Services, LLC | Counselor | 4424 Ne Glisan St, The Li Wellness Building, Second Floor, Portland, OR 97213 | 2019-03-08 |
| 1578049631 | Credena Health LLC | Pharmacy | 4805 Ne Glisan St Ste 11n321, Portland, OR 97213 | 2018-07-12 |
| 1023507795 | Karissa Lynn Schwartz | Speech-Language Pathologist | Providence Portland Medical Center, 4805 Ne Glisan St, Portland, OR 97213 | 2018-05-08 |
| 1861944506 | James Livingston Taylor | Chiropractor | 5212 Ne Sacremento St., Portland, OR 97213 | 2016-10-28 |
| 1962958520 | Caitlin Turner | Massage Therapist | 4317 Ne Tillamook St., Portland, OR 97213 | 2016-09-01 |
| 1326407008 | Julianna Vermeys | Counselor | 4605 Ne Fremont St., 209a, Portland, OR 97213 | 2016-02-23 |
| 1881059822 | Thomas Michael Barrett | Counselor | 5228 Ne Hoyt St. Bldg. B, Portland, OR 97213 | 2015-12-17 |
| Find all providers in zip 97213 | ||||
| Taxonomy Code | 261Q00000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| 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). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801413240 | Gfm LLC | Clinic/Center | 1235 Se Division St Ste 114, Portland, OR 97202-1042 | 2020-07-01 |
| 1134750037 | Legacy Good Samaritan Hospital and Medical Center | Clinic/Center | 1040 Nw 22nd Ave Ste 250, Portland, OR 97210-3057 | 2020-01-29 |
| 1679030290 | Yoana Kanev | Clinic/Center | 3701 Sw Condor Ave Apt C1, Portland, OR 97239-4158 | 2019-03-01 |
| 1841760584 | Orthopedic Needle LLC | Clinic/Center | 328 Ne Failing St Ste C, Portland, OR 97212-1157 | 2018-11-26 |
| 1073081881 | Sober Living Oregon Recovery Center | Clinic/Center | 1122 Ne 122nd Ave Ste A102, Portland, OR 97230-2082 | 2018-11-09 |
| 1366933830 | Dr Frances V Verzosa Md PC | Clinic/Center | 12770 Se Stark St Bldg C, Portland, OR 97233-1539 | 2018-05-21 |
| 1023520814 | Concordia Wellness, LLC | Clinic/Center | 3014 Ne Killingsworth St, Portland, OR 97211-6814 | 2017-11-01 |
| 1114443124 | Zephyr Acupuncture and Bodywork, LLC | Clinic/Center | 4313 Ne Tillamook St, Portland, OR 97213-1315 | 2017-08-22 |
| 1164952495 | Earth Source Medicine | Clinic/Center | 2207 Ne Broadway St Ste 200, Portland, OR 97232-1791 | 2017-06-19 |
| 1902353873 | Siesta Acupuncture LLC | Clinic/Center | 2818 Se 70th Ave, Portland, OR 97206-1117 | 2016-09-08 |
| 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.