PROVIDENCE HEALTH & SERVICES - OREGON (NPI# 1790881498) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790881498 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE HEALTH & SERVICES - OREGON |
| Other Organization Name | PROVIDENCE MEDICAL GROUP GATEWAY |
| Practice Address |
1321 Ne 99th Ave Suite 100 Portland OR 97220-9437 |
| Mailing Address |
Po Box 3158 Portland OR 97208-3158 |
| Practice Telephone | 5032154050 |
| Practice Fax Number | 5032154055 |
| Mailing Telephone | 5032156494 |
| Mailing Fax Number | 5032156644 |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2020-09-16 |
| Authorized Official Name | MR. DONALD W ANDERSON JR. (DIR REIMB REG STRAT/ASST SEC ENROLL) |
| Authorized Official Telephone | 4255255392 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261Q00000X | Clinic/Center | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 198127 | 05 |
| Other Name | Type Code |
|---|---|
| Providence Medical Group Gateway | 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 |
1321 NE 99TH AVE SUITE 100 |
| City | PORTLAND |
| State | OR |
| Zip Code | 97220-9437 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346234606 | Marina Mezey | Family Medicine | 1321 Ne 99th Ave, Suite 200, Portland, OR 97220-9436 | 2005-09-01 |
| 1740697432 | Adam Churey | Physician Assistant | 1321 Ne 99th Ave, Suite 100, Portland, OR 97220-9436 | 2014-07-15 |
| 1710307715 | Providence Health & Services - Oregon | Clinic/Center | 1321 Ne 99th Ave, Suite 110a, Portland, OR 97220-9436 | 2014-04-17 |
| 1497190409 | Keevin Bybee | Family Medicine | 1321 Ne 99th Ave, Ste 100, Portland, OR 97220-9436 | 2013-05-03 |
| 1588917009 | Claire-alyce Rochelle Gobble | Family Medicine | 1321 Ne 99th Ave, Suite 100, Portland, OR 97220-9436 | 2012-10-22 |
| 1790054831 | Elise J Mahoney | Nurse Practitioner | 1321 Ne 99th Ave, Suite 100, Portland, OR 97220-9436 | 2011-12-19 |
| 1649582610 | Yana I Bojilova Norman | Nurse Practitioner | 1321 Ne 99th Ave, Suite 100, Portland, OR 97220-9437 | 2010-07-07 |
| 1619290863 | Wajma Niazi | Physician Assistant | 1321 Ne 99th Ave, Ste 100, Portland, OR 97220-9437 | 2010-03-02 |
| 1326377235 | Vantrang Thi Nguyen | Family Medicine | 1321 Ne 99th Ave, Suite 100, Portland, OR 97220-9436 | 2009-12-24 |
| 1255566220 | Amber M Clark | Family Medicine | 1321 Ne 99th Ave, Ste 100, Portland, OR 97220-9436 | 2009-05-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316569254 | Debra Shamblin | Behavioral Analyst | 150 Ne 100th Ave, Portland, OR 97220 | 2020-05-14 |
| 1336780618 | Joan Lambert | Technician | 2802 Ne 108th Avenue, Portland, OR 97220 | 2019-10-08 |
| 1750933917 | Multnomah County | Clinic/Center | 11540 Ne Inverness Dr., Inverness Jail, Portland, OR 97220 | 2019-07-09 |
| 1194223107 | Landmark Connect of Oregon PC | General Practice | 5933 Ne Win Sivers Dr Ste 310, Portland, OR 97220 | 2018-01-24 |
| 1487178711 | Andrew Shonk | Massage Therapist | 163 Ne 102nd Ave Blid V, Portland, OR 97220 | 2017-07-28 |
| 1548781693 | Greater New Hope Family Services | Lodging | 11868 Ne Sandy Blvd, Portland, OR 97220 | 2017-06-29 |
| 1245771740 | Maria Teresa Banez Salcedo | Registered Nurse | 10300 Ne Hancock Street, Portland, OR 97220 | 2017-03-16 |
| 1568901858 | Christopher Gabriel Lyons | Adult Companion | 1343 Ne 118 Ave. Apt5, Portland, OR 97220 | 2017-02-20 |
| 1962945956 | Linda Ann Oldenburg | Registered Nurse | 9515 Ne Skidmore Avenue, Portland, OR 97220 | 2016-11-23 |
| 1326493446 | Trent D. Wilson | Massage Therapist | 8401 Ne Halsey St., Suite 101, Portland, OR 97220 | 2016-04-26 |
| Find all providers in zip 97220 | ||||
| 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.