Providence Health & Services - Oregon

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

Legal business name

PROVIDENCE HEALTH & SERVICES - OREGON

Practice address

1815 E 19TH St
Suite 1
The Dalles, OR 97058-3385

Phone

(541) 298-5563

NPI assigned

Aug 30, 2012

Organization subpart

No

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

Authorized official

Name

Mr. Donald W Anderson Jr.

Title

Assistant Secretary of Enrollments

Phone

(425) 358-9786

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 2

• PROVIDENCE MEDICAL GROUP Doing business as
• Providence The Dalles ENT Doing business as

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Natasha Catherine Edwin, M.D.

  • Internal Medicine Physician
  • Portland, OR
  • NPI 1063767317
  NPD
• Jaecelle Guadiz Galeniece, MD

  • Family Medicine Physician
  • Newberg, OR
  • NPI 1013321389
  NPD
• Isaac Kihoon Kim, MD

  • Internal Medicine Physician
  • Portland, OR
  • NPI 1801243530
  NPD
• Sarthak Sahu, MD

  • Internal Medicine Physician
  • Portland, OR
  • NPI 1942720883
  NPD
• Lori Tam

  • Cardiovascular Disease Physician
  • Portland, OR
  • NPI 1306036108
  NPD

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

{
    "created_epoch": "1346284800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750377600000",
    "number": "1083963573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31001-4180",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911104118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1815 E 19TH ST",
            "address_2": "SUITE 1",
            "city": "THE DALLES",
            "state": "OR",
            "postal_code": "970583385",
            "telephone_number": "541-298-5563"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH & SERVICES - OREGON",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-30",
        "last_updated": "2025-06-20",
        "certification_date": "2025-06-20",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY OF ENROLLMENTS",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500650976",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PROVIDENCE MEDICAL GROUP",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Providence The Dalles ENT",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Luis Miguel Preciado
• Kelsey Fern Pressel
• Jaime Marie Preston
• Kerry Anne Scully Proctor, MD
• Matthew David Proctor, MD
• Rachel Pruett
• Bernard Jeffrey Pulk, O.D.
• Jodie Quevedo
• Ludivina Quintanilla
• Jessica A Radley, PMHNP

• Otolaryngology Physician in The Dalles, OR
• Providers in The Dalles, OR by specialty
• Otolaryngology Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.