NPIMap

Organization Active NPI

University Professional Services

Doing business as UPS Gabriel Park (OHA PCPCH)

  • General Practice Physician
  • Portland, OR
National Provider Identifier
1033466206
Registry record updated Aug 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
UNIVERSITY PROFESSIONAL SERVICES
Doing business as
UPS Gabriel Park (OHA PCPCH)
Practice address
4411 SW Vermont St
Portland, OR 97219-1020
Phone
(503) 494-9992
NPI assigned
Aug 7, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2022

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

Authorized official

Name
Kelly Smith
Title
Vice President, Erc
Phone
(503) 494-8417

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X Primary

Addresses

Primary practice location

4411 SW Vermont St
Portland, OR 97219-1020

Mailing address

1400 SW 5TH Ave Ste 500
Portland, OR 97201-5537
Phone (503) 494-8417

Other identifiers 1

IdentifierTypeStateIssuer
500646498 (MCD)MedicaidOR

Other names 1

  • UPS Gabriel Park (OHA PCPCH) Doing business as

National Provider Directory

National Provider Directory
Tax ID family
University Professional Services18 organizations share this tax ID, including this one

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": "1344297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1659484800000",
    "number": "1033466206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 SW 5TH AVE STE 500",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972015537",
            "telephone_number": "503-494-8417",
            "fax_number": "503-346-8015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4411 SW VERMONT ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972191020",
            "telephone_number": "503-494-9992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY PROFESSIONAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-07",
        "last_updated": "2022-08-03",
        "certification_date": "2022-08-03",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "VICE PRESIDENT, ERC",
        "authorized_official_telephone_number": "503-494-8417"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500646498 (MCD)",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "UPS Gabriel Park (OHA PCPCH)",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "UPS Gabriel Park (OHA PCPCH)",
            "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 Aug 3, 2022; 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.