Active NPI
Thomas Joseph Prendergast, M.D.
- Pulmonary Disease Physician
- Portland, OR
National Provider Identifier
1093721524
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pulmonary Disease Physician
- License
- 9551
- Practice address
- 3710 SW US Veterans Hospital Rd
P-3-Pulm
Portland, OR 97239-1034 - Phone
- (503) 220-8262
- Fax
- (503) 721-7852
- NPI assigned
- Aug 1, 2006
- Last updated
- Mar 2, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Critical Care Medicine (Internal Medicine) Physician | 207RC0200X | 9551 | NH | |
| Pulmonary Disease Physician | 207RP1001X | 9551 | NH | Primary |
Addresses
Primary practice location
3710 SW US Veterans Hospital Rd
P-3-Pulm
Portland, OR 97239-1034
Mailing address
3710 SW US Veterans Hospital Road
P-3-Pulm, Portland Vamc
Portland, OR 97239-1034
Phone (503) 220-8262
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0RE3859 | Medicaid | VT | |
| 80003859 | Medicaid | NH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9551 | NH | MD | Pulmonary Disease Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154390400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1330646400000",
"number": "1093721524",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3710 SW US VETERANS HOSPITAL ROAD",
"address_2": "P-3-PULM, PORTLAND VAMC",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972391034",
"telephone_number": "503-220-8262",
"fax_number": "503-721-7852"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3710 SW US VETERANS HOSPITAL RD",
"address_2": "P-3-PULM",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972391034",
"telephone_number": "503-220-8262",
"fax_number": "503-721-7852"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PRENDERGAST",
"first_name": "THOMAS",
"middle_name": "JOSEPH",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-01",
"last_updated": "2012-03-02",
"status": "A"
},
"taxonomies": [
{
"code": "207RC0200X",
"taxonomy_group": "",
"desc": "Internal Medicine, Critical Care Medicine",
"state": "NH",
"license": "9551",
"primary": false
},
{
"code": "207RP1001X",
"taxonomy_group": "",
"desc": "Internal Medicine, Pulmonary Disease",
"state": "NH",
"license": "9551",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0RE3859",
"state": "VT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "80003859",
"state": "NH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
- Premise Health of Oregon Medical P C (DTNA - Portland)
- Premise Health of Oregon Medical PC (Leatherman - Portland)
- Janice C. Premo
- Valerie A Premore, MBA, PMP, CCRP
- Raisa Premysler, MD
- William John Prendergast III, MD
- Susan M Preneta
- Kathy Naylor Prenevost, MSW
- Caleb P Prentice, D.O.
- Danielle Marlene Prentice, D.O.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.