DR. DOUGLAS BRUCE MCKEAG (NPI# 1871558353) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871558353 |
| Entity Type | Individual |
| Full Name | DR. DOUGLAS BRUCE MCKEAG |
| Credential | MD, MS |
| Practice Address |
4411 Sw Vermont St Portland OR 97219-1020 |
| Practice Telephone | 5034949992 |
| Mailing Telephone | 5034949992 |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2014-07-25 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207QS0010X |
Family Medicine Specialization: Sports Medicine |
MD167303 | OR | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 200259190 | 05 | |
| IN | RR MEDICARE | P00800740 | 01 |
| Street Address |
4411 SW VERMONT ST |
| City | PORTLAND |
| State | OR |
| Zip Code | 97219-1020 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013434646 | Sarah Kuppenbender Kong | Nurse Practitioner | 4411 Sw Vermont St, Portland, OR 97219-1020 | 2017-08-24 |
| 1609396365 | Eric Wecker | Family Medicine | 4411 Sw Vermont St, Portland, OR 97219-1020 | 2017-06-23 |
| 1164896791 | Jan Haxby | Pharmacist | 4411 Sw Vermont St, Portland, OR 97219-1020 | 2015-11-19 |
| 1609289032 | Juliet F Baker | Specialist/Technologist | 4411 Sw Vermont St, Portland, OR 97219-1020 | 2014-06-03 |
| 1417204041 | Sarah S Owens | Social Worker | 4411 Sw Vermont St, Portland, OR 97219-1020 | 2012-08-14 |
| 1033466206 | University Professional Services | General Practice | 4411 Sw Vermont St, Portland, OR 97219-1020 | 2012-08-07 |
| 1215282710 | Claire E. Hull | Physician Assistant | 4411 Sw Vermont St, Portland, OR 97219-1020 | 2012-07-20 |
| 1699048686 | Pamela T English | Counselor | 4411 Sw Vermont St, Portland, OR 97219-1020 | 2012-02-21 |
| 1346536018 | Ruth Christiansen | Physician Assistant | 4411 Sw Vermont St, Portland, OR 97219-1020 | 2011-06-21 |
| 1609019686 | Jennifer S Mitchell | Physician Assistant | 4411 Sw Vermont St, Portland, OR 97219-1020 | 2009-04-07 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356958672 | Lighthouse Psychological Services, LLC | Psychologist | 630 Sw Nevada St, Ste. E, Poralnd, OR 97219 | 2020-09-30 |
| 1083130991 | Tawayne Nolen Malone Jr. | Psychologist | 0615 Sw Palatine Hill Road, Tawayne Malone - Msc 2159, Portland, OR 97219 | 2017-08-22 |
| 1548667918 | Eleven Eleven, LLC | Specialist/Technologist, Other | 6714 Sw 62nd Place, Portland, OR 97219 | 2014-12-01 |
| 1023414257 | Paul Shayne Hansen | Adult Companion | 9155 Sw 55th Avenue, Portland, OR 97219 | 2014-11-17 |
| 1154721850 | Mikhail Govshievich | Denturist | 9045 Sw Barbur Blvd. Suit 117, Portland, OR 97219 | 2014-08-29 |
| 1255749404 | Kristin Rae Paruszkiewicz | Physical Therapist | 7943 Sw Barbur Blvd #1, Portland, OR 97219 | 2014-07-31 |
| 1639436488 | Michelle Lorraine Emery | Counselor | 7912 Sw 35th, Portland, OR 97219 | 2012-04-18 |
| 1588930192 | Steve Ryan | Speech-Language Pathologist | 3315 Sw Falcon St, Portland, OR 97219 | 2012-03-28 |
| 1104145952 | Multnomah Family Care Center | Clinic/Center | 6787 Sw Capitol Hwy, Portland, OR 97219 | 2010-05-19 |
| 1740518331 | Trilbie L Patteson | Physical Therapy Assistant | 5701 Sw Multnomah Boulevard, West Hills Health and Rehab, Portland, OR 97219 | 2009-11-20 |
| Find all providers in zip 97219 | ||||
| Taxonomy Code | 207QS0010X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Sports Medicine |
| A family medicine physician that is trained to be responsible for continuous care in the field of sports medicine, not only for the enhancement of health and fitness, but also for the prevention of injury and illness. A sports medicine physician must have knowledge and experience in the promotion of wellness and the prevention of injury. Knowledge about special areas of medicine such as exercise physiology, biomechanics, nutrition, psychology, physical rehabilitation, epidemiology, physical evaluation, injuries (treatment and prevention and referral practice) and the role of exercise in promoting a healthy lifestyle are essential to the practice of sports medicine. The sports medicine physician requires special education to provide the knowledge to improve the health care of the individual engaged in physical exercise (sports) whether as an individual or in team participation. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Family Medicine, 2007. http://www.theabfm.org/. American Osteopathic Board of Family Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801079074 | Jennifer Dawn Kleinman | Family Medicine | 5704 N Montana Ave, Portland, OR 97217-4643 | 2007-12-11 |
| 1356305023 | David N Westerdahl | Family Medicine | 12672 Nw Barnes Rd Ste 100, Portland, OR 97229-6191 | 2006-04-12 |
| 1396739520 | William W Dexter | Family Medicine | 272 Congress St, Portland, ME 04102 | 2005-09-02 |
| 1346863727 | Sports Health Northwest Inc | Family Medicine | 12672 Nw Barnes Rd Ste 100, Portland, OR 97229-6191 | 2020-05-20 |
| 1518347897 | James Suchy | Family Medicine | 3181 Sw Sam Jackson Park Rd, Portland, OR 97239-3079 | 2015-06-02 |
| 1508278904 | James Alex | Family Medicine | 22 Bramhall St, Portland, ME 04102-3134 | 2014-05-20 |
| 1407266778 | Mary Iaculli | Family Medicine | 331 Veranda St, Portland, ME 04103-5545 | 2014-05-07 |
| 1114213667 | Alison Savage Lee | Family Medicine | 33 Sewall St, Portland, ME 04102-2603 | 2011-06-23 |
| 1952575391 | Melissa A. Novak | Family Medicine | 4411 Sw Vermont St, Gabriel Park Family Health Center, Portland, OR 97219-1020 | 2008-04-16 |
| 1174793301 | Ryan Carl Petering | Family Medicine | 3181 Sw Sam Jackson Park Rd, Portland, OR 97239-3011 | 2008-03-04 |
| 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.