NPIMap

Organization Active NPI

Sellwood Medical Clinic PC

  • Family Medicine Physician
  • Portland, OR
National Provider Identifier
1083686554
Registry record updated Sep 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD11101 Issued in OR
Legal business name
SELLWOOD MEDICAL CLINIC PC
Practice address
8332 SE 13TH Ave
Portland, OR 97202-7102
Phone
(503) 595-9300
Fax
(503) 233-1892
NPI assigned
Feb 7, 2006
Last updated
Sep 20, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2022

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

Authorized official

Name
Morgan Munoz
Title
Business Office Supervisor
Phone
(503) 595-9300

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X MD11101 OR Primary
Cardiovascular Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0000X MD06704 OR
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X P83603 OR

Addresses

Primary practice location

8332 SE 13TH Ave
Portland, OR 97202-7102

Mailing address

8332 SE 13TH Ave
Portland, OR 97202-7102
Phone (503) 595-9300

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040407001631 OR Part B Supplier - Clinic/Group Practice 3274526868 Receives reassigned benefits from 9 practitioners
Practice locations: Portland, OR

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
38D1012587Sellwood Medical Clinic8332 SE 13TH Ave, Portland, OR 97202Provider-performed microscopyFeb 29, 2028

National Provider Directory

National Provider Directory

Locations

9925 SW Nimbus Ave
Ste 10
Beaverton, OR 97008

6234 N Greeley Ave
Portland, OR 97217
Phone (503) 595-9300

8332 SE 13th Ave
Portland, OR 97202
Phone (503) 595-9300

8333 SE 13th Ave
Portland, OR 97202
Phone (503) 494-9300

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/3083/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 28

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.

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1139270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663632000000",
    "number": "1083686554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8332 SE 13TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972027102",
            "telephone_number": "503-595-9300",
            "fax_number": "503-233-1892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8332 SE 13TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972027102",
            "telephone_number": "503-595-9300",
            "fax_number": "503-233-1892"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SELLWOOD MEDICAL CLINIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-07",
        "last_updated": "2022-09-20",
        "certification_date": "2022-09-20",
        "status": "A",
        "authorized_official_last_name": "MUNOZ",
        "authorized_official_first_name": "MORGAN",
        "authorized_official_title_or_position": "BUSINESS OFFICE SUPERVISOR",
        "authorized_official_telephone_number": "503-595-9300"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "MD11101",
            "primary": true
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "OR",
            "license": "MD06704",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "P83603",
            "primary": false
        }
    ],
    "identifiers": [],
    "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 Sep 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.