Carl Anthony Riddick, M.D.

Primary specialty

Pulmonary Disease PhysicianTaxonomy code 207RP1001X

License

MD20646 Issued in OR

Practice address

9427 SW Barnes Rd Ste 296
Portland, OR 97225-6667

Phone

(503) 297-3778

Fax

(503) 297-7853

NPI assigned

Jun 22, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Legacy Meridian Park Hospital

  • General Acute Care Hospital
  • Tualatin, OR
  • NPI 1184647620
  Medicare reassignment NPD
• Providence Health & Services - Oregon

  • Clinic/Center
  • Medford, OR
  • NPI 1093976243
  Medicare reassignment NPD
• Providence Health & Services - Oregon

  • General Acute Care Hospital
  • Portland, OR
  • NPI 1114015971
  Medicare reassignment NPD
• Sound Physicians Intensivists of Washington PLLC

  • Critical Care Medicine (Internal Medicine) Physician
  • Spokane, WA
  • NPI 1528582699

  OR

  Medicare reassignment NPD
• Providence Health & Services - Oregon

  • General Acute Care Hospital
  • Newberg, OR
  • NPI 1952482275
  Medicare reassignment
• Providence Health & Services - Oregon

  • Clinical Pathology Physician
  • Medford, OR
  • NPI 1285185942
  NPD
• Providence Health & Services - Oregon

  • General Acute Care Hospital
  • Medford, OR
  • NPI 1689755670
  NPD
• Providence Health & Services - Oregon

  • Clinical Pathology Physician
  • Portland, OR
  • NPI 1831641745
  NPD

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

{
    "created_epoch": "1150934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637625600000",
    "number": "1093751372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "847 NE 19TH AVE",
            "address_2": "SUITE 300",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972322684",
            "telephone_number": "503-963-2801",
            "fax_number": "503-963-2825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9427 SW BARNES RD STE 296",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972256667",
            "telephone_number": "503-297-3778",
            "fax_number": "503-297-7853"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16770 SW Edy Rd Ste 216",
            "address_purpose": "LOCATION",
            "city": "Sherwood",
            "state": "OR",
            "postal_code": "971409679",
            "country_code": "US",
            "telephone_number": "503-297-3778",
            "fax_number": "503-297-7853",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "879 Providence Dr",
            "address_purpose": "LOCATION",
            "city": "Newberg",
            "state": "OR",
            "postal_code": "971327563",
            "country_code": "US",
            "telephone_number": "503-297-3778",
            "fax_number": "503-297-7853",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "19250 SW 65th Ave Ste 135",
            "address_purpose": "LOCATION",
            "city": "Tualatin",
            "state": "OR",
            "postal_code": "970627745",
            "country_code": "US",
            "telephone_number": "503-692-8560",
            "fax_number": "503-692-8562",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RIDDICK",
        "first_name": "CARL",
        "middle_name": "ANTHONY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-22",
        "last_updated": "2021-11-23",
        "certification_date": "2021-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "OR",
            "license": "MD20646",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "OR",
            "license": "MD20646",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2017144",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "150111",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "referringplmw@orclinic.direct-ct.net",
            "affiliation": "Y",
            "affiliationName": "The Oregon Clinic PC",
            "address_1": "9427 SW Barnes Rd Ste 296",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972256667",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Nicole Ricksgers
• La Tisha Rico
• Yadira Ricoy, QMHA
• Margaret Ridabock
• Brian Fielder Ridderbusch, RN
• Alicia M Riddle
• Andrew Lawrence Riddle, DMD
• Artur Riddle, MD, PHD
• Betty Riddle
• Emily Justusson Riddle, MD

• Pulmonary Disease Physician in Portland, OR
• Providers in Portland, OR by specialty
• Pulmonary Disease Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.