Heidi J Hansen, D.M.D.

Primary specialty

Oral Medicine DentistryTaxonomy code 125Q00000X

License

D11216 Issued in OR

Practice address

4805 NE Glisan St Ste 11N
Portland, OR 97213-2933

Phone

(503) 215-1676

NPI assigned

Apr 8, 2009

Last updated

Oct 23, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Electronic endpoints 1

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: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Undefined Physician Type (Specify)

Education

Other, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Providence Health and Services OregonGroup PAC ID 0648183608, 1,423 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Providence Portland Medical Center Hospital, Portland, OR, CCN 380061
• Providence St Vincent Medical Center Hospital, Portland, OR, CCN 380004

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Providence Health & Services Oregon

  dba Providence Medical Group

  • General Practice Physician
  • Lake Oswego, OR
  • NPI 1023488343
  Medicare reassignment Care Compare group NPD
• Providence Health & Services - Oregon

  dba Providence Portland Medical Center

  • General Acute Care Hospital
  • Portland, OR
  • NPI 1003991845
  Medicare reassignment NPD
• Providence Health & Services - Oregon

  dba Providence St Vincent Medical Center

  • General Acute Care Hospital
  • Portland, OR
  • NPI 1114015971
  Medicare reassignment NPD
• Providence Health & Services - Oregon

  dba Providence Dysplasia Clinic

  • Hematology & Oncology Physician
  • Portland, OR
  • NPI 1124325972
  NPD
• Providence Health & Services - Oregon

  dba Prov St. Vincent Medical Ctr

  • Clinical Pathology Physician
  • Portland, OR
  • NPI 1831641745
  NPD
• Providence Health & Services Oregon

  dba Providence Portland Medical Center

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Portland, OR
  • NPI 1396818993
  NPD
• Providence Health & Services Oregon

  dba Providence Medical Group

  • Psychiatry Physician
  • Portland, OR
  • NPI 1760177737
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Providence Health & Services - Oregon

  dba Providence Portland Medical Center

  • General Acute Care Hospital
  • Portland, OR
  • NPI 1003991845
  Care Compare affiliation
• Providence Health & Services - Oregon

  dba Providence St Vincent Medical Center

  • General Acute Care Hospital
  • Portland, OR
  • NPI 1114015971
  Care Compare affiliation
• Providence Health & Services - Oregon

  • Case Manager/Care Coordinator
  • Portland, OR
  • NPI 1891822995

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1239148800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698019200000",
    "number": "1063655967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3158",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083158",
            "telephone_number": "503-215-6494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4805 NE GLISAN ST STE 11N",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972132933",
            "telephone_number": "503-215-1676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HANSEN",
        "first_name": "HEIDI",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-04-08",
        "last_updated": "2023-10-23",
        "certification_date": "2023-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OR",
            "license": "D11216",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "055295",
            "primary": false
        },
        {
            "code": "125Q00000X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral Medicine",
            "state": "NY",
            "license": "055295",
            "primary": false
        },
        {
            "code": "125Q00000X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral Medicine",
            "state": "OR",
            "license": "D11216",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "hhansen1277181@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "4805 NE Glisan St Ste 11N",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972132933",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Eric B. Hansen, MD
• Eric Keith Hansen, MD
• Gary Hansen, MA
• Gregory Brent Hansen, MA
• Guy Hansen
• Jamie Hansen
• Jean Hansen, B.A.
• Jeremy Laurence Hansen, M.D.
• Jill R. Hansen, MD
• Joyanna Gilmour Hansen, PHD, RD

• Oral Medicine Dentistry in Portland, OR
• Providers in Portland, OR by specialty
• Oral Medicine Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.