KHALIL I. SHASHA (NPI# 1942233564) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1942233564 |
| Entity Type | Individual |
| Full Name | KHALIL I. SHASHA |
| Credential | MD |
| Practice Address |
19300 Sw 65th Ave Tualatin OR 97062-7706 |
| Mailing Address |
Po Box 3777 Portland OR 97208-3777 |
| Practice Telephone | 5034138407 |
| Practice Fax Number | 5034136951 |
| Mailing Telephone | 5034133900 |
| Enumeration Date | 2006-07-08 |
| Last Update Date | 2020-09-01 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | MD173729 | OR | Allopathic & Osteopathic Physicians |
| N | 207R00000X | Internal Medicine | MD00041482 | WA | Allopathic & Osteopathic Physicians |
| N | 208M00000X | Hospitalist | MD00041482 | WA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | DEPT OF L&I | 0279857 | 01 |
| WA | RR MEDICARE | P00946005 | 01 |
| WA | 1046292 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 400 S 43rd St, Southlake Clinic Inc Ps, Renton, WA 980555714 | 4252515110 | 4257934717 |
| Street Address |
19300 SW 65TH AVE |
| City | TUALATIN |
| State | OR |
| Zip Code | 97062-7706 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063417392 | Paul R Ash | Psychiatry & Neurology | 19300 Sw 65th Ave, Tualatin, OR 97062-7706 | 2005-06-14 |
| 1689217044 | Jacob White | Pharmacist | 19300 Sw 65th Ave, Tualatin, OR 97062-7706 | 2019-10-17 |
| 1679114011 | Jeri Leanne Shanahan | Pharmacist | 19300 Sw 65th Ave, Tualatin, OR 97062-7706 | 2019-10-07 |
| 1255840161 | Cinthia Marie Adair | Speech-Language Pathologist | 19300 Sw 65th Ave, Tualatin, OR 97062-7706 | 2017-09-22 |
| 1609311059 | Olivia Terris | Dietitian, Registered | 19300 Sw 65th Ave, Cardiac and Pulmonary Rehab, Tualatin, OR 97062-7706 | 2016-12-21 |
| 1568826386 | Kathryn Renee Foutch | Internal Medicine | 19300 Sw 65th Ave, Tualatin, OR 97062-7706 | 2016-04-07 |
| 1497129035 | Job Anderson | Pharmacist | 19300 Sw 65th Ave, Tualatin, OR 97062-7706 | 2015-11-19 |
| 1750775698 | Jessica Lorenz | Internal Medicine | 19300 Sw 65th Ave, Tualatin, OR 97062 | 2015-03-27 |
| 1528487956 | Raelin Fullmer I | Internal Medicine | 19300 Sw 65th Ave, Tualatin, OR 97062 | 2014-04-14 |
| 1497170849 | Legacy Meridan Park Hospital | Pharmacy | 19300 Sw 65th Ave, Tualatin, OR 97062-7706 | 2014-02-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467018739 | Activeedge Tualatin, LLP | Physical Therapist | 19150 Sw 90th Avenue, Suite 200, West Linn, OR 97062 | 2019-05-13 |
| 1932607934 | Naturalways Pediatrics | Clinic/Center | 18813 Sw Martiazzi Ave, Tualatin, OR 97062 | 2018-01-25 |
| 1831646280 | Elizabeth Erin Tafesse | Behavioral Analyst | 18765 Sw Boones Ferry Rd Suite 100, Tualatin, OR 97062 | 2016-09-01 |
| 1962851311 | Ana Mercedes Cerritos-sanchez | Community Health Worker | 19355 Sw 65th Ave Apt A5, Tualatin, OR 97062 | 2016-06-07 |
| 1952759318 | William Luke Summers | Counselor | 18840 Southwest Boones Ferry Rd, Suite 208, Tualatin, OR 97062 | 2016-05-26 |
| 1730536913 | Krystle Alligood | Behavioral Analyst | 18768 Sw Boones Ferry Road, Tualatin, OR 97062 | 2016-05-18 |
| 1760869739 | Oregon City Medical Nw, Inc | Clinic/Center | 6464 Sw Borland Road #d-4, Tualatin, OR 97062 | 2015-04-29 |
| 1396148904 | Tracy Filley | Clinical Nurse Specialist | 18840 Sw Boones Ferry Rd, Suite 208, Tualatin, OR 97062 | 2014-09-28 |
| 1043646474 | Michelle Lords | Registered Nurse | 7668 Sw Mohawk Street, Tualatin, OR 97062 | 2013-09-17 |
| 1871930750 | Sharon Ruth Frank | Social Worker | 7668 Sw Mohawk St., Aps Healthcare, Tualatin, OR 97062 | 2013-05-31 |
| Find all providers in zip 97062 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| 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 Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437382603 | Injury Specialists of Oregon PC | Internal Medicine | 19300 Sw Boones Ferry Rd Ste 1b, Tualatin, OR 97062-9065 | 2009-09-03 |
| 1225113731 | Seldon Keith Saks | Internal Medicine | 19300 Sw Boones Ferry Rd Ste 5, Tualatin, OR 97062-9086 | 2006-10-25 |
| 1275626137 | Richard P Miller | Internal Medicine | 6455 Sw Nyberg Ln, A109, Tualatin, OR 97062-9704 | 2006-10-02 |
| 1437127347 | Elizabeth Reyes Sammond | Internal Medicine | 19875 Sw 65th Ave Ste 100, Tualatin, OR 97062-8353 | 2006-03-08 |
| 1033100714 | Benito G Pataroque | Internal Medicine | 6485 Sw Borland Rd, Suite D, Tualatin, OR 97062-9762 | 2005-11-02 |
| 1639160369 | Tana Marie Haynes | Internal Medicine | 19260 Sw 65th Ave Ste 270, Suite B2, Tualatin, OR 97062-5705 | 2005-11-02 |
| 1053832162 | Tualatin Internal Medicine | Internal Medicine | 6485 Sw Borland Rd Ste B, Tualatin, OR 97062-9762 | 2017-06-28 |
| 1568826386 | Kathryn Renee Foutch | Internal Medicine | 19300 Sw 65th Ave, Tualatin, OR 97062-7706 | 2016-04-07 |
| 1750775698 | Jessica Lorenz | Internal Medicine | 19300 Sw 65th Ave, Tualatin, OR 97062 | 2015-03-27 |
| 1528487956 | Raelin Fullmer I | Internal Medicine | 19300 Sw 65th Ave, Tualatin, OR 97062 | 2014-04-14 |
| Find all providers in TUALATIN | ||||
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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.