Aika Shepard Gumboc, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

MD191830 Issued in OR

Practice address

5228 NE Hoyt St BLDG B
Portland, OR 97213-3055

Phone

(503) 215-4860

NPI assigned

Dec 16, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 2

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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 and National Provider Directory roles.

• Providence Health & Services - Oregon

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

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

  • Clinic/Center
  • Portland, OR
  • NPI 1346520327
  NPD
• Providence Health & Services Oregon

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

  • Psychiatry Physician
  • Portland, OR
  • NPI 1760177737
  NPD
• Providence Health & Services - Oregon

  • Internal Medicine Physician
  • Sherwood, OR
  • NPI 1184729329
  NPD (past)
• Providence Medical Group, PC

  • Internal Medicine Physician
  • Atlanta, GA
  • NPI 1063570604
  NPD (past)

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

{
    "created_epoch": "1134691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613347200000",
    "number": "1073599528",
    "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": "5228 NE HOYT ST BLDG B",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972133055",
            "telephone_number": "503-215-4860"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "US ARMY HEALTH CLINIC BLDG 687",
            "address_purpose": "LOCATION",
            "city": "SCHOFIELD BARRACKS",
            "state": "HI",
            "postal_code": "96857",
            "country_code": "US",
            "telephone_number": "808-433-8600",
            "fax_number": "808-433-8578",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GUMBOC",
        "first_name": "AIKA",
        "middle_name": "SHEPARD",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-16",
        "last_updated": "2021-02-15",
        "certification_date": "2021-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "DC",
            "license": "MD035343",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "OR",
            "license": "MD191830",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "agumboc1034831@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "9155 SW Barnes Rd Ste 634",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972256632",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "agumboc1034831@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "5228 NE Hoyt St Bldg B3",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972133055",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Scott M Gulstine, PT
• Patan Gultawatvichai, M.D.
• Lindsey Joy Gulya
• Leah Gulyas, RN
• Quinn Linden Gumbiner, LMT
• Christopher Allen Gumke, P.T.
• Laura Elise Gumpert
• Mark Kevin Gumtang, PT, DPT
• Nilana Sowbagya Gunasekaran, M.D.
• Sara Gunden

• Psychiatry Physician in Portland, OR
• Providers in Portland, OR by specialty
• Psychiatry Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.