NPIMap

Individual provider Active NPI

Paul Raymond Cieslak, M.D.

  • Infectious Disease Physician
  • Portland, OR
National Provider Identifier
1083758130
Registry record updated Mar 21, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
License
MD 19613 Issued in OR
Practice address
3007 NE 53Rd Ave
Portland, OR 97213-2439
Phone
(503) 287-3330
Fax
(971) 673-1100
NPI assigned
Feb 19, 2007
Last updated
Mar 21, 2009By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 21, 2009

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Infectious Disease Physician 207RI0200X MD 19613 OR Primary
Infectious Disease Physician 207RI0200X MD00025591 WA

Addresses

Primary practice location

3007 NE 53Rd Ave
Portland, OR 97213-2439

Mailing address

3007 NE 53Rd Ave
Portland, OR 97213-2439
Phone (503) 287-3330

Other identifiers 1

IdentifierTypeStateIssuer
232049MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, OR2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20050106000108 WA Practitioner - Infectious Disease 9133177199 Reassigns benefits to 2 organizations
I20130906000488 OR Practitioner - Infectious Disease 9133177199 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Infectious Disease
Education
Ohio State University College of Medicine, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Legacy Clinics LLCGroup PAC ID 0244144004, 714 clinicians
Legacy Salmon Creek HospitalGroup PAC ID 0446295711, 309 clinicians

Practice addresses (Care Compare)

1015 NW 22ND Ave
Portland, OR 97210-3025
Phone (503) 413-7711

1015 Nw22Nd Ave
Suite 34
Portland, OR 97210-3025
Phone (503) 413-6376

1130 NW 22ND Ave
Suite 220
Portland, OR 97210-2969
Phone (503) 413-8988

19300 SW 65TH Ave
Meridian Park Hosp
Portland, OR 97062-7706
Phone (503) 692-1212

2211 NE 139TH St
Vancouver, WA 98686-2742
Phone 3604871000360487

24800 SE Stark St
Gresham, OR 97030-3378
Phone (503) 413-8988

2801 N Gantenbein Ave
Portland, OR 97227-1623
Phone (503) 413-1122

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.62 of 100Reported as apm
Quality
77.21
Promoting interoperability
99.06
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
92.83 of 100Reported as group
Quality
96.26
Promoting interoperability
100
Improvement activities
40
Cost
79.84

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD 19613ORMDInfectious Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Vancouver Clinic Inc PS CurrentSince Nov 1, 2004 Accepting new patients
Legacy Salmon Creek Hospital CurrentSince Jul 3, 2013 Accepting new patients
Legacy Salmon Creek Hospital CurrentSince Jul 3, 2013 Accepting new patients
Legacy Clinics LLC CurrentSince Jul 3, 2013 Accepting new patients
Legacy Clinics LLC CurrentSince Jul 3, 2013 Accepting new patients
The Vancouver Clinic Inc PS Infectious Disease CurrentSince Nov 1, 2004 Accepting new patients

Locations

1015 NW 22nd Ave
#R200
Portland, OR 97210
Phone (503) 413-7074

1130 NW 22nd Ave
Ste 220
Portland, OR 97210
Phone (503) 413-4134

2211 NE 139th St
Vancouver, WA 98686
Phone (360) 397-1985

700 NE 87th Ave
Vancouver, WA 98664
Phone (360) 397-1500

Organizations & group practices 6

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.

Hospital & facility affiliations 9

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": "1171843200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1237593600000",
    "number": "1083758130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3007 NE 53RD AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972132439",
            "telephone_number": "503-287-3330",
            "fax_number": "971-673-1100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3007 NE 53RD AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972132439",
            "telephone_number": "503-287-3330",
            "fax_number": "971-673-1100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CIESLAK",
        "first_name": "PAUL",
        "middle_name": "RAYMOND",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-19",
        "last_updated": "2009-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "OR",
            "license": "MD 19613",
            "primary": true
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "WA",
            "license": "MD00025591",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "232049",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.