Individual provider Active NPI

Samuel Fritz Bremmer, M.D.

  • Dermatology Physician
  • Portland, OR
National Provider Identifier
1053553321
Registry record updated Apr 16, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
MD161920 Issued in OR
Practice address
3181 SW Sam Jackson Park Rd
Portland, OR 97239-3011
Phone
(503) 494-8211
NPI assigned
Apr 1, 2009
Last updated
Apr 16, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X MD161920 OR Primary

Addresses

Primary practice location

3181 SW Sam Jackson Park Rd
Portland, OR 97239-3011

Mailing address

2285 Corporate Cir
Ste 200
Henderson, NV 89074-7759
Phone (702) 360-2763

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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 1

Enrollment IDStateProvider typePAC IDDetails
I20130927000490 OR Practitioner - Dermatology 3375798028 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Micrographic Dermatologic Surgery (MDS)Also: Dermatology
Education
Oregon Health Sciences University School of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dermatology Clinic PCGroup PAC ID 3577559012, 14 clinicians

Practice addresses (Care Compare)

2441 Grear St NE
Salem, OR 97301-2749
Phone (503) 364-3321

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision31
Removal of skin lesions86
Removal of skin cancer369
Skin biopsy52

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Dermatology Clinic PC Dermatology CurrentSince Apr 9, 2017 Accepting new patients
J. Robert West, M.D., Inc Dermatology Past Accepting new patients
Dermatology Northwest LLC PastSince Aug 1, 2012 Accepting new patients

Locations

5900 Inland Shores Way N
Ste 202
Keizer, OR 97303
Phone (503) 463-6799

2441 Grear St NE
Salem, OR 97301
Phone (503) 364-3321

8642 SW Main St
Ste 100
Wilsonville, OR 97070
Phone (503) 463-6799

8840 SW Citizens Dr
Wilsonville, OR 97070
Phone (503) 364-2150

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

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": "1238544000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1460764800000",
    "number": "1053553321",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2285 CORPORATE CIR",
            "address_2": "STE 200",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890747759",
            "telephone_number": "702-360-2763",
            "fax_number": "949-783-2880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3181 SW SAM JACKSON PARK RD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972393011",
            "telephone_number": "503-494-8211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BREMMER",
        "first_name": "SAMUEL",
        "middle_name": "FRITZ",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-04-01",
        "last_updated": "2016-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "OR",
            "license": "MD161920",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.