NPIMap

Organization Active NPI

Oregon Health and Science University

Doing business as OHSU School of Dentistry

  • Dentist
  • Portland, OR
National Provider Identifier
1063596690
Registry record updated Mar 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
OREGON HEALTH AND SCIENCE UNIVERSITY
Doing business as
OHSU School of Dentistry
Practice address
2730 S Moody Ave
Portland, OR 97201-5042
Phone
(503) 494-8867
Fax
(503) 494-2365
NPI assigned
Oct 24, 2006
Last updated
Mar 21, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2023

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

Authorized official

Name
Phillip T Marucha, DMD, PHD
Title
Dean
Phone
(503) 494-8801

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X NU Primary

Addresses

Primary practice location

2730 S Moody Ave
Portland, OR 97201-5042

Mailing address

2730 S Moody Ave
Portland, OR 97201-5042
Phone (503) 494-8867

Other identifiers 2

IdentifierTypeStateIssuer
149518MedicaidOR
5729603MedicaidWA

Other names 1

  • OHSU School of Dentistry Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040121000929 OR Part B Supplier - Clinic/Group Practice 4284542945 Receives reassigned benefits from 88 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Portland, OR; La Grande, OR

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Oregon Health Sciences University26 organizations share this tax ID, including this one

Other organizations with this tax ID 25

Organizations that report the same tax identification number in the National Provider Directory.

View all 25

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679356800000",
    "number": "1063596690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2730 S MOODY AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972015042",
            "telephone_number": "503-494-8867",
            "fax_number": "503-494-2365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2730 S MOODY AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972015042",
            "telephone_number": "503-494-8867",
            "fax_number": "503-494-2365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OREGON HEALTH AND SCIENCE UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-24",
        "last_updated": "2023-03-21",
        "certification_date": "2023-03-21",
        "status": "A",
        "authorized_official_last_name": "MARUCHA",
        "authorized_official_first_name": "PHILLIP",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "DEAN",
        "authorized_official_telephone_number": "503-494-8801",
        "authorized_official_credential": "DMD, PHD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "149518",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5729603",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "OHSU School of Dentistry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "OHSU School of Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Mar 21, 2023; 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.