Active NPI
Tamara Pederson, PHD
- Clinical Psychologist
- Portland, OR
National Provider Identifier
1093756546
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 1995
- Practice address
- 2701 NW Vaughn Street
Suite 360
Portland, OR 97210 - Phone
- (503) 227-0671
- Fax
- (503) 227-0676
- NPI assigned
- Jun 8, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 801 | NH | |
| Clinical Psychologist | 103TC0700X | 1995 | OR | Primary |
Addresses
Primary practice location
2701 NW Vaughn Street
Suite 360
Portland, OR 97210
Mailing address
2701 NW Vaughn Street
Suite 360
Portland, OR 97210
Phone (503) 227-0671
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30423720 | 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 Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1995 | OR | MD | Naturopath |
| 801 | NH | MD | Physical Medicine & Rehabilitation Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pediatric Associates of the Northwest, PC | Past | Accepting new patients | |
| Speare Memorial Hospital | Past | Accepting new patients | |
| Pediatric Associates of the Northwest, PC | Past | Accepting new patients |
Organizations & group practices 3
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.
-
- Pediatrics Physician
- Beaverton, OR
- NPI 1528066859
-
- Pediatrics Physician
- Portland, OR
- NPI 1831054436
-
- Family Medicine Physician
- Meredith, NH
- NPI 1669161659
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149724800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1483056000000",
"number": "1093756546",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2701 NW VAUGHN STREET",
"address_2": "SUITE 360",
"city": "PORTLAND",
"state": "OR",
"postal_code": "97210",
"telephone_number": "503-227-0671",
"fax_number": "503-227-0676"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2701 NW VAUGHN STREET",
"address_2": "SUITE 360",
"city": "PORTLAND",
"state": "OR",
"postal_code": "97210",
"telephone_number": "503-227-0671",
"fax_number": "503-227-0676"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEDERSON",
"first_name": "TAMARA",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-08",
"last_updated": "2016-12-30",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NH",
"license": "801",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OR",
"license": "1995",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "30423720",
"state": "NH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.