Providence Health & Services Oregon
Organization Active NPI General Practice Physician · Lake Oswego, OR
NPI 1023488343 · NPPES record last updated Jun 20, 2025
Key facts
- NPI
- 1023488343
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Practice Physician 208D00000X
- Legal business name
- PROVIDENCE HEALTH & SERVICES OREGON
- Practice address
- 4823 Meadows Rd
Lake Oswego, OR 97035-2529 - Phone
- (503) 216-1580
- NPI assigned
- Sep 29, 2015
- Organization subpart
- No
Authorized official
- Name
- Donald Wayne Anderson Jr.
- Title
- Asst Secretary for Enrollment
- Phone
- (425) 525-5392
Other NPIs on the same Medicare enrollment 14
Other NPIs with the same Medicare PAC ID 3
Practitioners 1,902
-
Heather S Abe, DO
-
Traci A Ackron, D.O.
-
Bethany Adams, DNP, AGACNP
-
Rhezarie Mae A Agtarap, NP-C
-
Claire Elena Alexander, MSN, NP, FNP-BC
-
Linda Reeves Alexander, DPT, OCS
-
Erin J Allen, MD
-
Prakash Ambady, M.D.
-
Zachary Amos, DO
-
Maureen C Andersen, CNM
-
Elise Anderson, MD
-
Kori Lynn Anderson, FNP
-
Ellen L Andrae, MD
-
Caitlin Connor Ansel, FNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in OR, WA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031106000652 | OR | Part B Supplier - Clinic/Group Practice | 0648183608 | Receives reassigned benefits from 1,658 practitioners |
| O20080630000201 | WA | Part B Supplier - Clinic/Group Practice | 0648183608 |
Receives reassigned benefits from 77 practitioners 15 other NPIs on this enrollment This NPI is an additional NPI on the enrollment |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician |
208D00000X | Yes | ||
| Clinic/Center | 261Q00000X |
Addresses
Primary practice location
4823 Meadows Rd
Lake Oswego, OR 97035-2529
Mailing address
PO Box 31001 - 4180
Pasadena, CA 91110-4180
Other names
- PROVIDENCE MEDICAL GROUP
Other providers in Lake Oswego, OR
- Kathleen Elizabeth Preuss
- Pro-Tech Sports Medicine, Inc.
- Proactive Health Resources, LLC
- Providence Health & Services - Oregon
- Providence Health & Services - Oregon
- Amber Nicole Pruitt
- Robin Prusse
- Psych NW, PC
- Valeria Puk
- Judith Pullan
All providers in Lake Oswego, OR · General Practice Physician in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 20, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.