The Portland Clinic Laboratory

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

THE PORTLAND CLINIC LABORATORY

Practice address

800 SW 13TH Ave
Portland, OR 97205

Phone

(503) 221-0161

Fax

(503) 274-1697

NPI assigned

Feb 28, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Dick Clark

Title

Ceo

Phone

(503) 221-0161

Specialties & licenses 1

Addresses

Other identifiers 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 63

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Christine Ahlbrecht, PT

  • Physical Therapist
  • Portland, OR
  • NPI 1891740239
  NPD
• Ronald Doran Allen, D.O.

  • Ophthalmology Physician
  • Portland, OR
  • NPI 1376516294
  NPD
• Scott Harrison Ambruster, M.D.

  • Vascular & Interventional Radiology Physician
  • Salem, OR
  • NPI 1760686505
  NPD
• Prasanna Rama Chandran

  • Family Medicine Physician
  • Beaverton, OR
  • NPI 1861567729
  NPD
• Bryan C Chitwood, MD

  • Family Medicine Physician
  • Beaverton, OR
  • NPI 1619197480
  NPD
• Young K Choi, M.D.

  • Gastroenterology Physician
  • Portland, OR
  • NPI 1336122274
  NPD
• Ashley Crabb, NP

  • Adult Health Nurse Practitioner
  • Beaverton, OR
  • NPI 1295596492
  NPD
• Jonathan Clark Crist, M.D.

  • Sports Medicine (Family Medicine) Physician
  • Hillsboro, OR
  • NPI 1134252851
  NPD
• Robert C. Crouse, M.D.

  • Internal Medicine Physician
  • Hillsboro, OR
  • NPI 1659339083
  NPD
• Michael Patric Cunningham, PA-C

  • Physician Assistant
  • Tigard, OR
  • NPI 1154517175
  NPD
• Reewen C. D'Souza-Kamath, M.D.

  • Internal Medicine Physician
  • Beaverton, OR
  • NPI 1831192756
  NPD
• Thomas Dudrey

  • Internal Medicine Physician
  • Portland, OR
  • NPI 1376906669
  NPD

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

{
    "created_epoch": "1172620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603670400000",
    "number": "1053448795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 SW 13TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97205",
            "telephone_number": "503-221-0161",
            "fax_number": "503-274-1697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 SW 13TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97205",
            "telephone_number": "503-221-0161",
            "fax_number": "503-274-1697"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE PORTLAND CLINIC LABORATORY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-28",
        "last_updated": "2020-10-26",
        "certification_date": "2020-10-26",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "DICK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "503-221-0161",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "38D06235",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• The Oregon Physical Therapy & Sports Medicine Center
• The Owl Den Massage and Bodywork LLC
• The Perpetual Dawn LLC
• The Pink Nut LLC
• The Point Psychiatry
• The Practice of Jeffery Wise Therapeutics Pmhnp-BC
• The Quiet Grove Massage LLC
• The Radiology Group PC
• The Reed Institute
• The Ren Clinic

• All providers in Portland, OR
• Clinical Medical Laboratory in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.