NPIMap

Organization Active NPI

Providence Health & Service - Oregon

  • PACE Provider Organization
  • Portland, OR
National Provider Identifier
1023738424
Registry record updated May 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
PACE Provider OrganizationTaxonomy code 251T00000X
Legal business name
PROVIDENCE HEALTH & SERVICE - OREGON
Practice address
4400 NE Halsey St
Building 1, Ste 200
Portland, OR 97213
Phone
(503) 215-6556
Fax
(503) 215-0685
NPI assigned
Aug 29, 2022
Organization subpart
Yes
Parent organization
PROVIDENCE HEALTH & SERVICES - OREGONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 16, 2025

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

Authorized official

Name
Donald Wayne Anderson
Title
Assistant Secretary of Enrollments
Phone
(425) 358-9786

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PACE Provider Organization 251T00000X Primary

Addresses

Primary practice location

4400 NE Halsey St
Building 1, Ste 200
Portland, OR 97213

Mailing address

4400 NE Halsey St
Building 1, Ste 200
Portland, OR 97213
Phone (503) 215-6556

Other identifiers 1

IdentifierTypeStateIssuer
005673MedicaidOR

Other names 1

  • Providence ElderPlace - Portland Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Wilson Medical Group18 organizations share this tax ID, including this one
Part of
Wilson Medical Group

Other organizations with this tax ID 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1661731200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747353600000",
    "number": "1023738424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4400 NE HALSEY ST",
            "address_2": "BUILDING 1, STE 200",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97213",
            "telephone_number": "503-215-6556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4400 NE HALSEY ST",
            "address_2": "BUILDING 1, STE 200",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97213",
            "telephone_number": "503-215-6556",
            "fax_number": "503-215-0685"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH & SERVICE - OREGON",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROVIDENCE HEALTH & SERVICES - OREGON",
        "enumeration_date": "2022-08-29",
        "last_updated": "2025-05-16",
        "certification_date": "2025-05-16",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY OF ENROLLMENTS",
        "authorized_official_telephone_number": "425-358-9786"
    },
    "taxonomies": [
        {
            "code": "251T00000X",
            "taxonomy_group": "",
            "desc": "Program of All-Inclusive Care for the Elderly (PACE) Provider Organization",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005673",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence ElderPlace - Portland",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Providence ElderPlace - Portland",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.