Sellwood Medical Clinic PC
Organization Active NPI Family Medicine Physician · Portland, OR
NPI 1083686554 · NPPES record last updated Sep 20, 2022
Key facts
- NPI
- 1083686554
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- MD11101 (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
- Organization subpart
- No
Authorized official
- Name
- Morgan Munoz
- Title
- Business Office Supervisor
- Phone
- (503) 595-9300
Practitioners 28
-
Heather N Davidson, PA-C
-
Nancy Casey, NP
-
Amanda Colleen Krbec, FNP
-
Leslie Diane Gregory, P.A.C
-
Casey Ryan Magis-Agosta, CPNP-PC, APRN, MSN
-
Rachel Kathryn Rittenhouse, DNP, ARNP, CPNP-PC
-
Kaitlyn Simmons, MD, MPH
-
Younghee Kim, DNP
-
Jeffrey Meyrowitz, M.D.
-
Deanna Read, CPNP-PC
-
Tara Ann Schwab, M.D.
-
Shannon K Sherry, PAC
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 38D1012587 | Sellwood Medical Clinic | Provider-performed microscopy | Feb 29, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040407001631 | OR | Part B Supplier - Clinic/Group Practice | 3274526868 |
Receives reassigned benefits from 9 practitioners Practice locations: Portland, OR |
National Provider Directory
Locations
9925 SW Nimbus Ave
Ste 10
Beaverton, OR 97008
8332 SE 13th Ave
Portland, OR 97202
Phone (503) 595-9300
6234 N Greeley Ave
Portland, OR 97217
Phone (503) 595-9300
8333 SE 13th Ave
Portland, OR 97202
Phone (503) 494-9300
Interoperability endpoints
- https://api.platform.athenahealth.com/3083/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | MD11101 | OR | Yes |
| Cardiovascular Disease Physician |
207RC0000X | MD06704 | OR | |
| Physician Assistant |
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
Other providers in Portland, OR
- Clifford Wayne Sells
- Meghan E. Sells
- Sellwood Counseling Services
- Sellwood Family Medicine
- Sellwood Landin
- Sellwood Senior Living LLC
- Calina Brooke Selmanson
- Annette U Selmer
- Shelley Suzanne Selph
- Margaret Catherine Sels
All providers in Portland, OR · Family Medicine Physician in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 20, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.