NPIMap

Individual provider Active NPI

Michael David Fox, D.O.

  • Internal Medicine Physician
  • Portland, OR
National Provider Identifier
1043685407
Registry record updated Jun 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
DO192476 Issued in OR
Practice address
1015 NW 22ND Ave # 230
Portland, OR 97210-3025
Phone
(503) 413-7711
NPI assigned
Dec 9, 2015
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 26, 2019

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X PG177909 OR
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X DO192476 OR Primary

Addresses

Primary practice location

1015 NW 22ND Ave # 230
Portland, OR 97210-3025

Mailing address

1015 NW 22ND Ave # 230
Portland, OR 97210-3025
Phone (503) 413-7711

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190801001929 OR Practitioner - Internal Medicine 4789977992 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Legacy Clinics LLCGroup PAC ID 0244144004, 714 clinicians

Practice addresses (Care Compare)

2801 N Gantenbein Ave
Portland, OR 97227-1623
Phone (503) 413-2200

Hospital & facility affiliations

  • Legacy Good Samaritan Medical Center Hospital, Portland, OR, CCN 380017
  • Legacy Emanuel Medical Center Hospital, Portland, OR, CCN 380007

Merit-based Incentive Payment System (MIPS)

Final score
94.62 of 100Reported as apm
Quality
77.21
Promoting interoperability
99.06
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
DO192476ORMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Silverton Health CurrentSince Mar 20, 2020 Accepting new patients
Silverton Health Current Accepting new patients
Legacy Clinics LLC CurrentSince Aug 4, 2019 Accepting new patients
Silverton Health CurrentSince Mar 20, 2020 Accepting new patients
Legacy Clinics LLC Internal Medicine CurrentSince Aug 4, 2019 Accepting new patients

Locations

1015 NW 22nd Ave
Portland, OR 97210
Phone (503) 413-7582

2800 N Vancouver Ave
Ste 230
Portland, OR 97227
Phone (503) 413-2901

1015 NW 22nd Ave
#230
Portland, OR 97210

1130 NW 22nd Ave
Ste 220
Portland, OR 97210
Phone (503) 413-4134

2801 N Gantenbein Ave
Portland, OR 97227
Phone (503) 413-2200

342 Fairview St
Silverton, OR 97381
Phone (503) 525-7660

Organizations & group practices 5

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 6

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

NPI Registry JSON

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

{
    "created_epoch": "1449619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561507200000",
    "number": "1043685407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1015 NW 22ND AVE # 230",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972103025",
            "telephone_number": "503-413-7711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1015 NW 22ND AVE # 230",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972103025",
            "telephone_number": "503-413-7711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOX",
        "first_name": "MICHAEL",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-12-09",
        "last_updated": "2019-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "OR",
            "license": "PG177909",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "DO192476",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.