Active NPI
Randy Lee Ellerbrook, M.D.
- Internal Medicine Physician
- Portland, OR
National Provider Identifier
1063584217
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- MD08564
- Practice address
- 9155 SW Barnes Rd
Suite 205
Portland, OR 97225-6625 - Phone
- (503) 297-5581
- Fax
- (503) 297-1421
- NPI assigned
- Nov 14, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | MD08564 | OR | Primary |
Addresses
Primary practice location
9155 SW Barnes Rd
Suite 205
Portland, OR 97225-6625
Mailing address
9155 SW Barnes Rd
Suite 230
Portland, OR 97225-6625
Phone (503) 445-3235
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 055715 | Medicaid | OR | |
| 110104202 | Other | OR | RAILROAD MEDICARE/PALMETT |
| 003335013 | Other | OR | REGENCE BLUE CROSS OF OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Westside Internal Medicine | Internal Medicine | Past | Accepting new patients |
| Westside Internal Medicine | Internal Medicine | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Internal Medicine Physician
- Portland, OR
- NPI 1407932098
-
- Internal Medicine Physician
- Portland, OR
- NPI 1972771327
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163462400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1211846400000",
"number": "1063584217",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9155 SW BARNES RD",
"address_2": "SUITE 230",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972256625",
"telephone_number": "503-445-3235",
"fax_number": "503-790-2293"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9155 SW BARNES RD",
"address_2": "SUITE 205",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972256625",
"telephone_number": "503-297-5581",
"fax_number": "503-297-1421"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLERBROOK",
"first_name": "RANDY",
"middle_name": "LEE",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-14",
"last_updated": "2008-05-27",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "OR",
"license": "MD08564",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "055715",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE/PALMETT",
"identifier": "110104202",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE BLUE CROSS OF OR",
"identifier": "003335013",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.