NPIMap

Organization Active NPI

Providence Health & Services - Oregon

Doing business as Providence Portland Medical Center

  • Psychiatric Hospital Unit
  • Portland, OR
National Provider Identifier
1023194271
Registry record updated May 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Hospital UnitTaxonomy code 273R00000X
Legal business name
PROVIDENCE HEALTH & SERVICES - OREGON
Doing business as
Providence Portland Medical Center
Practice address
4805 NE Glisan St
Portland, OR 97213-2933
Phone
(503) 215-4323
Fax
(503) 215-0297
NPI assigned
Oct 31, 2006
Last updated
May 14, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
PROVIDENCE HEALTH & SERVICES - OREGONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 14, 2025

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

Authorized official

Name
Donald W Anderson Jr.
Title
Assistant Secretary Enrollments
Phone
(425) 358-9786

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital Unit 273R00000X Primary
General Acute Care Hospital 282N00000X

Addresses

Primary practice location

4805 NE Glisan St
Portland, OR 97213-2933

Mailing address

PO Box 31001-4199
Pasadena, CA 91110-4199
Phone (503) 215-4323

Other identifiers 2

IdentifierTypeStateIssuer
0000ZBBVWOtherORPART B MEDICARE PTAN
023981MedicaidOR

Other names 1

  • Providence Portland Medical Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070924000493 OR Part A Provider - Hospital 5395656284 Practice locations: Portland, OR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1023194271. Details of each certification follow.

Hospital certification: CCN 38S061

Legal name
PROVIDENCE HEALTH & SERVICES - OREGON
Doing business as
PROVIDENCE PORTLAND MEDICAL CENTER
Organization structure
CorporationNon-profit
Incorporated
Feb 20, 1934 in OR
Enrollment address
4805 NE Glisan St
Portland, OR 97213-2933
Hospital Psychiatric Unit
Hospital subgroups
Psychiatric unit

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Providence Health Srvcs-Or10 organizations share this tax ID, including this one
Part of
Providence Portland Medical Center

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 26

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Diane L Hejna Individual Corporate DirectorBoard Member Jul 1, 2016
Richard S Blair Individual Corporate DirectorBoard Member Jul 1, 2016
Providence Health & Services-Oregon Organization, Renton, WA Non-profit 5% Or Greater Direct Ownership Interest Jul 1, 2016 100%
Marvin O'Quinn Individual Corporate DirectorBoard Member Jan 1, 2024
Linda Buck Individual Corporate DirectorBoard Member Jan 1, 2025
Krista Farnham Individual W-2 Managing EmployeeChief Executive May 10, 2018
Providence Health & Services - Washington Organization, Renton, WA Operational/Managerial Control May 17, 2010
Mary E Lyons Individual Corporate DirectorBoard Member Jul 1, 2016
Phyllis M Hughes Individual Corporate DirectorBoard Member Jan 1, 2014
Rogelio Riojas Individual Corporate DirectorBoard Member Jan 1, 2025
James Martin Individual Corporate Officer Jan 13, 2023
Charles Wallace Sorenson Individual Corporate DirectorBoard Member Jan 1, 2019
Kathryn C Buzbee Individual W-2 Managing EmployeeFinance Executive Jan 1, 2025
Donald Wayne Anderson Individual Corporate OfficerAssistant Secretary of Enrollments Jan 1, 2017
Gregory David Hoffman Individual Corporate OfficerCfo/Treasurer Jan 1, 2023
Isiaah D Crawford Individual Corporate DirectorBoard Member Jan 1, 2012
Melissa Ann Damm Individual W-2 Managing EmployeeOregon Cfo Jul 20, 2016
Donna Markham Individual Corporate DirectorBoard Member Jan 1, 2024
Michael W Murphy Individual Corporate DirectorBoard Member Jan 1, 2020
Providence Health & Services Organization, Renton, WA Non-profit Other Jul 1, 2016
Mary Beth Kingston Individual Corporate Director Sep 1, 2022
Eric D Sprunk Individual Corporate Director Jan 1, 2022
Anna R Newsom Individual Corporate Officer May 13, 2022
Darryl Elmouchi Individual Corporate OfficerPresident/Ceo Apr 1, 2025
Karin Dufault Individual Corporate DirectorBoard Member Jan 1, 2025
Providence St. Joseph Health Organization, Renton, WA Non-profit Other Jul 1, 2016

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Providence Portland Medical CenterPortland, OR, CCN 38T061 Hospital 5% Or Greater Direct Ownership Interest (100%) May 17, 2010

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 139

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 139

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1162252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747180800000",
    "number": "1023194271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31001-4199",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911104199",
            "telephone_number": "503-215-4323",
            "fax_number": "503-215-0297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4805 NE GLISAN ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972132933",
            "telephone_number": "503-215-4323",
            "fax_number": "503-215-0297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH & SERVICES - OREGON",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROVIDENCE HEALTH & SERVICES - OREGON",
        "enumeration_date": "2006-10-31",
        "last_updated": "2025-05-14",
        "certification_date": "2025-05-14",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY ENROLLMENTS",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PART B MEDICARE PTAN",
            "identifier": "0000ZBBVW",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "023981",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Portland Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Providence Portland Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.