NPIMap

Individual provider Active NPI

Ben Lawrence Pederson, M.D.

  • Family Medicine Physician
  • Portland, OR
National Provider Identifier
1073856142
Registry record updated Oct 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD171441 Issued in OR
Practice address
4104 SE 82ND Ave Ste 250
Portland, OR 97266-2954
Phone
(503) 215-9850
Fax
(503) 215-9855
NPI assigned
Mar 27, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD171441 OR Primary

Addresses

Primary practice location

4104 SE 82ND Ave Ste 250
Portland, OR 97266-2954

Mailing address

PO Box 3158
Portland, OR 97208-3158

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address bpederson831003@oc.providencedirect.org
Direct Messaging Address bpederson831003@oc.providencedirect.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150623002865 OR Practitioner - Family Practice 8022259613 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Minnesota Medical School, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

4104 SE 82ND Ave
Suite 250
Portland, OR 97266-2954
Phone (503) 215-9850

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services - Oregon CurrentSince Sep 1, 2017 Accepting new patients
Providence Health & Services Oregon CurrentSince Sep 1, 2017 Accepting new patients
Kaiser Foundation Health Plan of the Northwest Family Medicine Current Accepting new patients
Kaiser Foundation Health Plan of the Northwest Family Medicine CurrentSince Apr 4, 2015 Accepting new patients
Providence Health & Services Oregon Current Accepting new patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Apr 4, 2015 Accepting new patients
Providence Health & Services Oregon Family Medicine CurrentSince Apr 16, 2023 Accepting new patients
Providence Health & Services Oregon CurrentSince Sep 1, 2017 Accepting new patients
Providence Health & Services Oregon Current Accepting new patients
Providence Health & Services Oregon CurrentSince Apr 16, 2023 Accepting new patients
Providence Health & Services - Oregon Family Medicine Past Accepting new patients

Locations

10100 SE Sunnyside Rd
Clackamas, OR 97015
Phone (503) 571-2946

10150 SE 32nd Ave
Portland, OR 97222
Phone (503) 215-4202

10330 SE 32nd Ave
Ste 205
Portland, OR 97222
Phone (503) 513-8950

4104 SE 82nd Ave
Ste 250
Portland, OR 97266
Phone (503) 215-9850

1321 NE 99th Ave
Ste 200
Portland, OR 97220
Phone (503) 215-4250

3550 N Interstate Ave
Ofc
Portland, OR 97227
Phone (503) 285-9321

4805 NE Glisan St
Portland, OR 97213
Phone (503) 215-1111

2400 Lancaster Dr NE
Salem, OR 97305
Phone (503) 361-5400

Interoperability endpoints

  • Direct secure messaging: bpederson831003@oc.providencedirect.org

Organizations & group practices 11

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.

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1364342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601856000000",
    "number": "1073856142",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4104 SE 82ND AVE STE 250",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972662954",
            "telephone_number": "503-215-9850",
            "fax_number": "503-215-9855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEDERSON",
        "first_name": "BEN",
        "middle_name": "LAWRENCE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-03-27",
        "last_updated": "2020-10-05",
        "certification_date": "2020-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "MD171441",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bpederson831003@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "4104 SE 82nd Ave Ste 250",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972662954",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bpederson831003@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "10330 SE 32nd Ave Ste 205",
            "city": "Milwaukie",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972226594",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.