Providence Health & Services - Oregon

Primary specialty

Hematology (Internal Medicine) PhysicianTaxonomy code 207RH0000X

Legal business name

PROVIDENCE HEALTH & SERVICES - OREGON

Doing business as

Providence Medical Group
Providence Medical Group Anticoagulation Telephone Management

Practice address

3300 SE Dwyer Dr
Suite 304
Milwaukie, OR 97222-6548

Phone

(503) 513-8043

NPI assigned

Jul 3, 2014

Last updated

Jun 20, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Donald Wayne Anderson Jr.

Title

Assistant Secretary Enrollment

Phone

(425) 358-9786

Specialties & licenses 2

Addresses

Other names 2

• PROVIDENCE MEDICAL GROUP Doing business as
• Providence Medical Group Anticoagulation Telephone Management Doing business as

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Phat Q Tran, PA-C

  • Physician Assistant
  • Canby, OR
  • NPI 1518639038
  NPD

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

{
    "created_epoch": "1404345600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750377600000",
    "number": "1053727636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31001 - 4180",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911104180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 SE DWYER DR",
            "address_2": "SUITE 304",
            "city": "MILWAUKIE",
            "state": "OR",
            "postal_code": "972226548",
            "telephone_number": "503-513-8043"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH & SERVICES - OREGON",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-03",
        "last_updated": "2025-06-20",
        "certification_date": "2025-06-20",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY ENROLLMENT",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RH0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PROVIDENCE MEDICAL GROUP",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Providence Medical Group Anticoagulation Telephone Management",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Providence Medical Group Anticoagulation Telephone Management",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jennifer Primers, LMT
• Jessica M Prior, PHARMD
• Maria V Prokhorova, MD
• Protech Automotive Inc
• Providence Health & Services - Oregon (Providence Medical Group)
• Providence Health & Services - Oregon (Providence Medical Group)
• Providence Health & Services - Oregon (Providence Hospitalists Southeast)
• Providence Health & Services - Oregon (Providence Medical Group)
• Providence Health & Services - Oregon (Providence Medical Group)
• Providence Health & Services Oregon (Providence Milwaukie Hospital)

• Hematology (Internal Medicine) Physician in Milwaukie, OR
• Providers in Milwaukie, OR by specialty
• Hematology (Internal Medicine) Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.