PROVIDENCE HEALTH & SERVICES - OREGON (NPI# 1790113405) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790113405 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE HEALTH & SERVICES - OREGON |
| Other Organization Name | PROVIDENCE HEALTH EXPRESS BP |
| Practice Address |
18040 Sw Lower Boones Ferry Rd Suite 100 Tigard OR 97224-7259 |
| Mailing Address |
Po Box 3158 Portland OR 97208-3158 |
| Practice Telephone | 8552296460 |
| Practice Fax Number | 5032160710 |
| Enumeration Date | 2013-10-16 |
| Last Update Date | 2013-10-16 |
| Authorized Official Name | KEENAN B FREEMAN (CFO) |
| Authorized Official Telephone | 5038936524 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261Q00000X | Clinic/Center | Ambulatory Health Care Facilities | ||
| Y | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers |
| Other Name | Type Code |
|---|---|
| Providence Health eXpress BP | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922481456 | Providence Health & Services - Oregon | Psychiatry & Neurology | 10830 Highway 62, Eagle Point, OR 97524-9516 | 2015-07-01 |
| 1023440435 | Providence Health & Services - Oregon | General Acute Care Hospital | 11445 Se Moon Dust Ct, Happy Valley, OR 97086-8033 | 2013-08-08 |
| 1568793313 | Providence Health & Services - Oregon | Clinic/Center | 17550 Provost St Ste 201, Lake Oswego, OR 97034-5199 | 2010-01-19 |
| 1508015348 | Providence Health & Services - Oregon | Clinic/Center | 16180 Se Sunnyside Road, Suite 102, Happy Valley, OR 97015-6302 | 2008-09-17 |
| 1114085545 | Providence Health & Services - Oregon | Internal Medicine | 1314 E Sherman St, Newberg, OR 97132-1842 | 2006-12-05 |
| 1629146121 | Providence Health & Services - Oregon | Otolaryngology | 310 Villa Rd, Suite 104, Newberg, OR 97132-1886 | 2006-12-01 |
| 1992882500 | Providence Health & Services - Oregon | Clinic/Center | 205 N Phoenix Rd, Suite A, Phoenix, OR 97535-9104 | 2006-11-01 |
| 1013018175 | Providence Health & Services - Oregon | Clinic/Center | 510 Bridge St, Vernonia, OR 97064-1218 | 2006-09-25 |
| 1447799523 | Providence Health & Services - Oregon | Clinic/Center | 1698 E Mcandrews Rd Ste 170, Medford, OR 97504-5590 | 2017-02-22 |
| 1063963106 | Providence Health & Services - Oregon | Clinic/Center | 1698 E Mcandrews Rd, Ste 300, Medford, OR 97504-5589 | 2016-10-24 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Colorado Business Entities | Providence Health & Services - Oregon | 1801 Lind Avenue, Sw, Renton, WA 98057-9016 |
| Oregon Corporations, Companies and Business Names | PROVIDENCE HEALTH & SERVICES - OREGON | 1801 Lind Ave Sw #9016, Renton, WA 98057 |
| System for Award Management (SAM) Entities | PROVIDENCE HEALTH & SERVICES - OREGON | 4400 Ne Halsey St Bldg 2 Ste 690, Portland, OR 97213-1545 |
| Iowa Business Entities | PROVIDENCE HEALTH & SERVICES - OREGON | 1801 Lind Ave. Sw, Renton, WA 98057 |
| Washington State Corporations | PROVIDENCE HEALTH & SERVICES - OREGON | 1801 Lind Ave Sw # 9016, Renton, WA 98057 |
| Street Address |
18040 SW LOWER BOONES FERRY RD SUITE 100 |
| City | TIGARD |
| State | OR |
| Zip Code | 97224-7259 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952384430 | Pamela A. Devisser | Nurse Practitioner | 18040 Sw Lower Boones Ferry Rd, Suite 100, Tigard, OR 97224-7258 | 2005-11-29 |
| 1689211740 | Gabrielle Johnson | Specialist/Technologist | 18040 Sw Lower Boones Ferry Rd, Tigard, OR 97224-7258 | 2019-12-06 |
| 1326588708 | Susan Kathleen Glinka | Psychologist | 18040 Sw Lower Boones Ferry Rd, Suite 304, Tigard, OR 97224-7258 | 2017-03-03 |
| 1720402472 | Providence Health & Services - Oregon | Internal Medicine | 18040 Sw Lower Boones Ferry Rd, Suite 204, Tigard, OR 97224-7259 | 2014-02-14 |
| 1689097131 | Providence Health & Services - Oregon | Internal Medicine | 18040 Sw Lower Boones Ferry Rd, Suite 204, Tigard, OR 97224-7259 | 2014-02-03 |
| 1669726345 | Deborah Ann Jones | Physical Therapist | 18040 Sw Lower Boones Ferry Rd, Tigard, OR 97224-7258 | 2012-11-02 |
| 1568749539 | Heather Leann Adair | Physician Assistant | 18040 Sw Lower Boones Ferry Rd, Suite 100, Tigard, OR 97224-7258 | 2011-11-04 |
| 1568756591 | Michael D Goodwin | Family Medicine | 18040 Sw Lower Boones Ferry Rd, Ste 100, Tigard, OR 97224-7258 | 2011-06-07 |
| 1245549724 | Providence Health & Services Oregon | Clinic/Center | 18040 Sw Lower Boones Ferry Rd, Suite 207, Tigard, OR 97224-7259 | 2010-09-30 |
| 1275842957 | Lisa Rose Lundin | Pharmacist | 18040 Sw Lower Boones Ferry Rd, Tigard, OR 97224-7258 | 2010-09-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154973139 | Katherine Raineri | Psychologist | 7213 Sw Hazel Fern Rd, Tigard, OR 97224 | 2019-07-10 |
| 1871064618 | Stacey A Wenzel | Speech-Language Pathologist | 17020 Sw Upper Boones Ferry Rd.,suite 201, Tigard, OR 97224 | 2018-12-05 |
| 1376010090 | Meredith Rae Brezinski | Physical Therapist | 18019 Sw Boones Ferry Road, Tigard, OR 97224 | 2018-10-31 |
| 1649759358 | Viktoriya A Chiliy | Behavior Technician | 15290 Sw Royalty Parkway, Tigard, OR 97224 | 2018-08-13 |
| 1609384866 | Rachel E King | Physical Therapist | 18040 Sw Lower Boones Ferry Rd Ste 200, Tigard, OR 97224 | 2018-01-22 |
| 1689190134 | Isabelle Cooper Klee Caballero | Speech-Language Pathologist | 17020 Sw Upper Boones Ferry Road Suite 201, Tigard, OR 97224 | 2017-08-16 |
| 1427573146 | Breanna M Sandefur | Behavior Technician | 15290 Sw Royalty Pkwy, Tigard, OR 97224 | 2017-08-03 |
| 1083141196 | Krista Espenship | Registered Nurse | 8032 Sw Ashford St, Tigard, OR 97224 | 2017-05-19 |
| 1275067928 | Emily Elizabeth Myers | Behavioral Analyst | 15290 Royalty Parkway, Tigard, OR 97224 | 2017-04-19 |
| 1235684937 | Melanie Salvador | Nurse Practitioner | 15352 Sw Oakmont Pl, Tigard, OR 97224 | 2016-08-23 |
| Find all providers in zip 97224 | ||||
| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407161318 | Kaycee Suzanne Sargent | Nurse Practitioner | 9225 Sw Hall Blvd Ste G, Tigard, OR 97223-6794 | 2010-08-16 |
| 1497792295 | Marla Sue Hostetter Kropf | Nurse Practitioner | 13200 Sw Pacific Hwy, Tigard, OR 97223 | 2006-06-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124628417 | Biohax | Nurse Practitioner | 17933 Nw Evergreen Pkwy Ste 285, Beaverton, OR 97006-7661 | 2020-10-27 |
| 1932708526 | Rebecca Ann Mickel | Nurse Practitioner | 22244 Sw Nottingham Ct, Sherwood, OR 97140-9816 | 2020-10-23 |
| 1184221780 | Catherine Slade | Nurse Practitioner | 3640 Nw Samaritan Dr # 100, Corvallis, OR 97330-3784 | 2020-10-06 |
| 1689280620 | Danna Rae Morgan | Nurse Practitioner | 539 N Barneburg Rd, Medford, OR 97504-6678 | 2020-09-16 |
| 1740800283 | Digital Clinic LLC | Nurse Practitioner | 30 E 33rd Ave Unit 5822, Eugene, OR 97405-0819 | 2020-04-24 |
| 1356977144 | Maria Elena Rivera | Nurse Practitioner | 1801 Highway 99 N Ste B, Ashland, OR 97520-9152 | 2020-03-12 |
| 1114577368 | Heather Ashley Fronek | Nurse Practitioner | 2825 E. Barnett Rd., Medford, OR 97504 | 2019-09-18 |
| 1073097242 | Shirley Deveere Reynolds | Nurse Practitioner | 998 Inlet Loop, Coos Bay, OR 97420-4446 | 2018-09-24 |
| 1427537844 | Mardin Sabah Sabir | Nurse Practitioner | 5050 Ne Hoyt St Ste 259, Portland, OR 97213-2984 | 2018-08-07 |
| 1497249007 | Kansys Clouse | Nurse Practitioner | 1639 Se Ensign Ln # B103, Warrenton, OR 97146-7308 | 2018-06-18 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on PROVIDENCE HEALTH & SERVICES - OREGON.
| 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.