Individual provider Active NPI

Susan Esther Johnson, M.D.

  • Gastroenterology Physician
  • Portland, OR
National Provider Identifier
1043434814
Registry record updated Nov 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
MD27861 Issued in OR
Practice address
9701 SW Barnes Rd Ste 300
Portland, OR 97225-6689
Phone
(503) 297-8081
Fax
(503) 292-6601
NPI assigned
Apr 12, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X MD27861 OR Primary

Addresses

Primary practice location

9701 SW Barnes Rd Ste 300
Portland, OR 97225-6689

Mailing address

541 NE 20TH Ave Ste 225
Portland, OR 97232-2895
Phone (503) 963-2801

Other identifiers 2

IdentifierTypeStateIssuer
213841MedicaidOR
2004400MedicaidWA

Other names 1

  • Dr. Susan Esther Chan Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address cc_otoc_gastro_west_front_desk_pool12223293@oc.providencedirect.org The Oregon Clinic PC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, WA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20080417000533 OR Practitioner - GastroenterologyPractitioner - Internal Medicine 0648358572 Reassigns benefits to 2 organizations
I20091210000213 WA Practitioner - GastroenterologyPractitioner - Internal Medicine 0648358572 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
Oregon Health Sciences University School of Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
The Oregon Clinic, PCGroup PAC ID 2860390408, 353 clinicians

Practice addresses (Care Compare)

1111 NE 99TH Ave
Portland, OR 97220-9442

5050 NE Hoyt
Suite 655
Portland, OR 97213-2990
Phone (503) 239-6673

9701 SW Barnes
Suite 300
Portland, OR 97225-6689
Phone (503) 297-8081

Hospital & facility affiliations

  • Providence St Vincent Medical Center Hospital, Portland, OR, CCN 380004
  • Adventist Health Tillamook Hospital, Tillamook, OR, CCN 381317
  • Columbia Memorial Hospital Hospital, Astoria, OR, CCN 381320
  • Providence Seaside Hospital Hospital, Seaside, OR, CCN 381303
  • Providence Portland Medical Center Hospital, Portland, OR, CCN 380061

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy42
Upper gastrointestinal (GI) endoscopy for acid reflux51

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
The Oregon Clinic, PC CurrentSince Oct 1, 2021 Accepting new patients
The Oregon Clinic PC Gastroenterology CurrentSince Oct 1, 2021 Accepting new patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Oct 5, 2009 Accepting new patients

Locations

10100 SE Sunnyside Rd
Clackamas, OR 97015
Phone (503) 571-2946

9900 SE Sunnyside Rd
Clackamas, OR 97015
Phone (503) 571-8240

5050 NE Hoyt St
Ste 655
Portland, OR 97213
Phone (503) 239-6673

7201 N Interstate Ave
Portland, OR 97217
Phone (503) 240-4051

541 NE 20th Ave
Ste 225
Portland, OR 97232
Phone (503) 963-2801

847 NE 19th Ave
Ste 300
Portland, OR 97232

9701 SW Barnes Rd
Ste 300
Portland, OR 97225
Phone (503) 297-8081

2400 Lancaster Dr NE
Salem, OR 97305
Phone (503) 361-5400

1230 7th Ave
Longview, WA 98632
Phone (360) 575-4801

7101 NE 137th Ave
Vancouver, WA 98682
Phone (360) 418-6000

Networks

  • WA PPO C-SNP
  • devoted network organization-83621310-88c0-4660-8f8d-b8ea8f4dc04e

Interoperability endpoints

  • Direct secure messaging: sjohnson101958@oc.providencedirect.org

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1176336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731888000000",
    "number": "1043434814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "541 NE 20TH AVE STE 225",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972322895",
            "telephone_number": "503-963-2801",
            "fax_number": "503-963-2825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9701 SW BARNES RD STE 300",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972256689",
            "telephone_number": "503-297-8081",
            "fax_number": "503-292-6601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "SUSAN",
        "middle_name": "ESTHER",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-12",
        "last_updated": "2024-11-18",
        "certification_date": "2024-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "OR",
            "license": "MD27861",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "213841",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2004400",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cc_otoc_gastro_west_front_desk_pool12223293@oc.providencedirect.org",
            "affiliation": "Y",
            "affiliationName": "The Oregon Clinic PC",
            "address_1": "9701 SW Barnes Rd Ste 300",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972256689",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "SUSAN",
            "last_name": "CHAN",
            "middle_name": "ESTHER",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.