Roberts Street Clinic, P.C.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

DO18839 Issued in OR

Legal business name

ROBERTS STREET CLINIC, P.C.

Practice address

400 NE Roberts Ave
Gresham, OR 97030-7464

Phone

(503) 669-3066

Fax

(503) 665-6404

NPI assigned

May 18, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Linda Mankey

Title

Clinic Manager

Phone

(503) 669-3066

Specialties & licenses 4

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Locations

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Toni Loraine Hero, D.O.

  • Family Medicine Physician
  • Gresham, OR
  • NPI 1851387849
  Medicare reassignment NPD
• Steven Douglas Maness, M.D.

  • Internal Medicine Physician
  • Gresham, OR
  • NPI 1700872785
  Medicare reassignment NPD
• Matthew Clay Upshaw, D.O.

  • Family Medicine Physician
  • Portland, OR
  • NPI 1407842487
  Medicare reassignment NPD
• Sue A Lewis, MD

  • Internal Medicine Physician
  • Lake Oswego, OR
  • NPI 1366559577
  NPD
• Courtney Denise Mercier, RD

  • Registered Dietitian
  • Corvallis, OR
  • NPI 1952028813
  NPD
• Christine Louise Altamirano, RDN

  • Registered Dietitian
  • Portland, OR
  • NPI 1316729536
  NPD (past)
• Valeria Rech, RD

  • Registered Dietitian
  • Portland, OR
  • NPI 1285168435
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191974400000",
    "number": "1003024423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 NE ROBERTS AVE",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970307464",
            "telephone_number": "503-669-3066",
            "fax_number": "503-665-6404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 NE ROBERTS AVE",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970307464",
            "telephone_number": "503-669-3066",
            "fax_number": "503-665-6404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBERTS STREET CLINIC, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-18",
        "last_updated": "2007-10-10",
        "status": "A",
        "authorized_official_last_name": "MANKEY",
        "authorized_official_first_name": "LINDA",
        "authorized_official_title_or_position": "CLINIC MANAGER",
        "authorized_official_telephone_number": "503-669-3066"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "DO15150",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "DO21884",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "DO18839",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "MD17149",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "205823",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "287658",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "029582",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "079546",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "287698",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Susan E Rivard-Dibenedetto, PA C
• Miguel Angel Rivera-Morales, CRM
• Rnfa Assist, LLC
• Robert L Kalez MD PC
• Robert W Ramsey DC PC
• Carol Lynn Roberts, MA, LPC
• Casey Leigh Roberts
• Caterina Elana Robertson, RN
• Devinity Larraine Robertson
• Andrea R Robideau, QMHA

• Family Medicine Physician in Gresham, OR
• Providers in Gresham, OR by specialty
• Family Medicine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.