Individual provider Active NPI

Swapna Bokka Reddy, M.D.

  • Gastroenterology Physician
  • Tualatin, OR
National Provider Identifier
1114106507
Registry record updated Dec 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
MD162099 Issued in OR
Practice address
19250 SW 90TH Ave
Tualatin, OR 97062-7585
Phone
(503) 692-3750
Fax
(503) 691-2324
NPI assigned
Nov 1, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X MD162099 OR Primary

Addresses

Primary practice location

19250 SW 90TH Ave
Tualatin, OR 97062-7585

Mailing address

847 NE 19TH Ave
Suite 300
Portland, OR 97232-2684
Phone (503) 963-2801

Other practice location 1

879 N Providence Dr
Newberg, OR 97132-7563
Phone (503) 692-3750

Other identifiers 2

IdentifierTypeStateIssuer
1114106507MedicaidWA
500657127MedicaidOR

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address referringgso@orclinic.direct-ci.net The Oregon Clinic PC

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20130828000633 OR Practitioner - Gastroenterology 1951454909 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
The Oregon Clinic, PCGroup PAC ID 2860390408, 353 clinicians

Practice addresses (Care Compare)

19250 SW 90TH Ave
Tualatin, OR 97062-7585
Phone (503) 692-3750

Hospital & facility affiliations

  • Providence Newberg Medical Center Hospital, Newberg, OR, CCN 380037
  • Legacy Meridian Park Medical Center Hospital, Tualatin, OR, CCN 380089
  • Providence Willamette Falls Medical Center Hospital, Oregon City, OR, CCN 380038
  • Ohsu Hospital and Clinics Hospital, Portland, OR, CCN 380009
  • Providence Portland Medical Center Hospital, Portland, OR, CCN 380061

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy47
Upper gastrointestinal (GI) endoscopy for acid reflux61

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
The Oregon Clinic PC Internal Medicine Current Accepting new patients
The Oregon Clinic, PC CurrentSince Sep 16, 2013 Accepting new patients
Oregon Clinic PC CurrentSince Sep 16, 2013 Accepting new patients

Locations

879 N Providence Dr
Newberg, OR 97132
Phone (503) 297-3778

1508 Division St
Ste 15
Oregon City, OR 97045
Phone (503) 657-5555

847 NE 19th Ave
Ste 300
Portland, OR 97232

5050 NE Hoyt St
Ste 655
Portland, OR 97213
Phone (503) 239-6673

500 N Highway
Saint Helens, OR 97051
Phone (503) 229-7554

875 Oak St SE
Ste 5020
Salem, OR 97301
Phone (503) 371-4044

19250 SW 90th Ave
Tualatin, OR 97062
Phone (503) 692-3750

Interoperability endpoints

  • Direct secure messaging: sreddy312729@oc.providencedirect.org

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.

Hospital & facility affiliations 7

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": "1193875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638316800000",
    "number": "1114106507",
    "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": "19250 SW 90TH AVE",
            "city": "TUALATIN",
            "state": "OR",
            "postal_code": "970627585",
            "telephone_number": "503-692-3750",
            "fax_number": "503-691-2324"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "879 N Providence Dr",
            "address_purpose": "LOCATION",
            "city": "Newberg",
            "state": "OR",
            "postal_code": "971327563",
            "country_code": "US",
            "telephone_number": "503-692-3750",
            "fax_number": "503-691-2324",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "REDDY",
        "first_name": "SWAPNA",
        "middle_name": "BOKKA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-11-01",
        "last_updated": "2021-12-01",
        "certification_date": "2021-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "OR",
            "license": "MD162099",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1114106507",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500657127",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "referringgso@orclinic.direct-ci.net",
            "affiliation": "Y",
            "affiliationName": "The Oregon Clinic PC",
            "address_1": "879 N Providence Dr",
            "city": "Newberg",
            "state": "OR",
            "country_code": "US",
            "postal_code": "971327563",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Tualatin, OR

Sources for this page

Verify at the official NPI Registry.