SUSAN E OMURA (NPI# 1477576239) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1477576239 |
| Entity Type | Individual |
| Full Name | SUSAN E OMURA |
| Credential | MD |
| Practice Address |
2801 N Gantenbein Ave Portland OR 97227-1623 |
| Mailing Address |
6312 Sw Capitol Hwy #502 Portland OR 97239-1938 |
| Practice Telephone | 5034134121 |
| Mailing Telephone | 5034649034 |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2019-02-04 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207PP0204X |
Emergency Medicine Specialization: Pediatric Emergency Medicine |
MD23697 | OR | Allopathic & Osteopathic Physicians |
| N | 208000000X | Pediatrics | MD23697 | OR | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 286909 | 05 |
| Street Address |
2801 N GANTENBEIN AVE |
| City | PORTLAND |
| State | OR |
| Zip Code | 97227-1623 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124027198 | James P Mccord | Pediatrics | 2801 N Gantenbein Ave, Portland, OR 97227-1623 | 2005-07-20 |
| 1225639040 | Lina Rossetti-grulich | Nurse Practitioner | 2801 N Gantenbein Ave, Portland, OR 97227-1623 | 2020-11-06 |
| 1033722673 | Karen Bronson | Pharmacist | 2801 N Gantenbein Ave, Portland, OR 97227-1623 | 2020-08-24 |
| 1356969331 | Sandy Hammer | Pharmacist | 2801 N Gantenbein Ave, Portland, OR 97227-1623 | 2020-07-07 |
| 1225673999 | Odaisa Igwe | Pharmacist | 2801 N Gantenbein Ave, Portland, OR 97227-1623 | 2019-11-16 |
| 1952945578 | Julie Lorine Hoover | Pharmacist | 2801 N Gantenbein Ave, Portland, OR 97227-1623 | 2019-11-06 |
| 1285278648 | Kate Harrell Unterberger | Pharmacist | 2801 N Gantenbein Ave, Portland, OR 97227-1623 | 2019-10-29 |
| 1780227082 | Keegan Carly Fritzke | Pharmacist | 2801 N Gantenbein Ave, Portland, OR 97227-1623 | 2019-10-21 |
| 1578106860 | Corinne Frohlick | Pharmacist | 2801 N Gantenbein Ave, Portland, OR 97227-1623 | 2019-10-20 |
| 1386287662 | Aimee Breitfelder Reddy | Pharmacist | 2801 N Gantenbein Ave, Portland, OR 97227-1623 | 2019-10-19 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508466574 | Jessica Michelle Simonetti | Psychologist | Portland Psychotherapy Clinic, Research and Training Ce, 3700 N Williams Ave, Portland, OR 97227 | 2020-10-29 |
| 1447812268 | Maksim Yefimov | Physician Assistant | 2800 N Vancouver Ave Ste 130, Portland, OR 97227 | 2019-07-01 |
| 1851955975 | Erin Marie Staples | Student in an Organized Health Care Education/Training Program | 2800 N. Vancouver Ave;, Suite 230, Portland, OR 97227 | 2019-04-24 |
| 1922588508 | Melanie Grace Mix | Physician Assistant | 501 N Graham St Ste 420, Portland, OR 97227 | 2018-08-14 |
| 1730615071 | Mehran Giblin | Student in an Organized Health Care Education/Training Program | 2800 N. Vancouver Ave, Suite 230, Legacy Clinic Emanuel, Portland, OR 97227 | 2017-05-05 |
| 1730623687 | Christina Grace Belter | Optometrist | 300 N Graham St Ste 300, Portland, OR 97227 | 2016-12-12 |
| 1407300205 | Jenna Abernathy | Counselor | 3537 N Williams Ave, Portland, OR 97227 | 2016-08-09 |
| 1215390760 | Tanya Marie Woods | Massage Therapist | 3808 N. Williams Ave., Portland, OR 97227 | 2016-04-01 |
| 1033596853 | Eric Allen Martin | Counselor | 2054 N. Vancouver Ave, Portland, OR 97227 | 2015-04-30 |
| 1285040436 | Berk Neurosurgical LLC | Neurological Surgery | 501 N Graham St Ste 500, Portland, OR 97227 | 2014-07-09 |
| Find all providers in zip 97227 | ||||
| Taxonomy Code | 207PP0204X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| Specialization | Pediatric Emergency Medicine |
| Pediatric Emergency Medicine is a clinical subspecialty that focuses on the care of the acutely ill or injured child in the setting of an emergency department. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Emergency Medicine, 2007. http://www.abem.org/public/ Board certification is provided by the American Board of Emergency Medicine. Board certification for Medical Doctors (MDs) is provided by the American Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760574230 | Robert Louis Cloutier | Emergency Medicine | 3181 Sam Jackson Park Rd, Ohsu Department of Emergency Medicine, Portland, OR 97239-3098 | 2006-09-29 |
| 1376748459 | Esther Lok-yan Yue | Emergency Medicine | 3181 Sw Sam Jackson Park Rd, Portland, OR 97239-3011 | 2007-06-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033279633 | Beverly H. Bauman | Emergency Medicine | 2865 Daggett Ave, Klamath Falls, OR 97601-1106 | 2006-12-12 |
| 1699796201 | Kathleen M Smith | Emergency Medicine | 10690 Ne Cornell Rd Ste 220, Hillsboro, OR 97124-9224 | 2006-07-21 |
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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.