PACIFIC MEDICAL GROUP, PC (NPI# 1477636561) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1477636561 |
| Entity Type | Organization |
| Organization Name | PACIFIC MEDICAL GROUP, PC |
| Practice Address |
6 Centerpointe Drive, Ste 200 Lake Oswego OR 97035 |
| Mailing Address |
6 Centerpointe Dr Ste 200 Lake Oswego OR 97035-8660 |
| Practice Telephone | 5032346381 |
| Practice Fax Number | 5032348151 |
| Mailing Telephone | 5032346381 |
| Mailing Fax Number | 5032348151 |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2007-11-20 |
| Authorized Official Name | DR. SUSAN M CLACK (CEO) |
| Authorized Official Telephone | 5035982000 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261Q00000X | Clinic/Center | OR | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 230547 | 05 | |
| OR | 230550 | 05 | |
| OR | 230548 | 05 | |
| OR | 230549 | 05 | |
| OR | 230589 | 05 | |
| OR | RR MEDICARE | CC6737 | 01 |
| Street Address |
6 CENTERPOINTE DRIVE, STE 200 |
| City | LAKE OSWEGO |
| State | OR |
| Zip Code | 97035 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932700127 | Teresa Siebenaler Scott | Social Worker | 3990 Sw Collins Way, Suite 202, Lake Owsego, OR 97035 | 2020-11-04 |
| 1528671567 | Martin Henry Lees | Internal Medicine | 14 Morningview Lane, Lake Oswego, OR 97035 | 2020-08-28 |
| 1356976187 | Premere Rehab LLC | Occupational Therapist | Infinity Rehab - The Springs At Lake Oswego, 3900 Kruse Way Pl, Lake Oswego, OR 97035 | 2020-03-12 |
| 1689212193 | Jennifer Chauvin | Nurse Practitioner | 20 Juarez Street, Lake Oswego, OR 97035 | 2019-12-16 |
| 1003396888 | Sarah Guenzburger | Physical Therapist | 3900 Kruse Way Pl, Lake Oswego, OR 97035 | 2018-08-21 |
| 1568964252 | Brett Johnson | Marriage & Family Therapist | 5655 Southwood Dr, Lake Oswego, OR 97035 | 2018-03-08 |
| 1912416561 | Michael Paul Long | Social Worker | 14523 Westlake Drive, Lake Oswego, Or 97035, Lake Oswego, OR 97035 | 2017-09-27 |
| 1467807859 | Misty Lohn | Nurse Practitioner | 5 Centerpointe Dr., Ste 600, Lake Oswego, OR 97035 | 2016-05-04 |
| 1326405473 | Kelsey Prince | Behavioral Analyst | 6400 Sw Rosewood St., Portland (lake Oswego), OR 97035 | 2016-01-20 |
| 1942683388 | Elizabeth Risberg Harrison | Massage Therapist | 190 Oswego Summit, Lake Oswego, OR 97035 | 2015-07-02 |
| Find all providers in zip 97035 | ||||
| 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 |
|---|---|---|---|---|
| 1205272267 | Z Clinic LLC | Clinic/Center | 16250 Bryant Rd, Suite 101, Lake Oswego, OR 97035-4300 | 2013-05-17 |
| 1568793313 | Providence Health & Services - Oregon | Clinic/Center | 17550 Provost St Ste 201, Lake Oswego, OR 97034-5199 | 2010-01-19 |
| 1578893962 | Monarch Medical Group LLC | Clinic/Center | 17020 Pilkington, Lake Oswego, OR 97035 | 2010-01-06 |
| 1063860377 | Deni R Buss, Lmt | Clinic/Center | 14511 Westlake Dr, Suite 100, Lake Oswego, OR 97035-7783 | 2016-05-26 |
| 1023488343 | Providence Health & Services - Oregon | Clinic/Center | 4823 Meadows Rd, Lake Oswego, OR 97035-2529 | 2015-09-29 |
| 1982033494 | Amer J Mirza, Md PC | Clinic/Center | 4103 Mercantile Dr, Lake Oswego, OR 97035 | 2013-11-05 |
| 1376887992 | Justice Clinical Consults Inc | Clinic/Center | 315 2nd St, Lake Oswego, OR 97034-3114 | 2012-11-20 |
| 1639438419 | Janice Modesitt Lmt | Clinic/Center | 16463 Boones Ferry Rd, Ste. 100, Lake Oswego, OR 97035-4259 | 2012-05-14 |
| 1801062179 | Oakridge Medical Clinic | Clinic/Center | 4309 Oakridge Rd, Lake Oswego, OR 97035-3418 | 2008-05-06 |
| 1205937273 | Providence Health & Services - Oregon | Clinic/Center | 4015 Mercantile Dr, Suite 200, Lake Oswego, OR 97035-2552 | 2006-09-25 |
| Find all providers in LAKE OSWEGO | ||||
| City | LAKE OSWEGO |
| Zip Code | 97035 |
Please comment or provide details below to improve the information on PACIFIC MEDICAL GROUP, PC.
| 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.