Organization Active NPI

Bridgetown Medical Group P.C.

  • Surgery Physician
  • Portland, OR
National Provider Identifier
1124088679
Registry record updated Jun 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
BRIDGETOWN MEDICAL GROUP P.C.
Practice address
10000 SE Main St
Suite 311
Portland, OR 97216
Phone
(503) 257-0748
Fax
(503) 255-0526
NPI assigned
Mar 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2018

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

Authorized official

Name
Lindsay Shaw
Title
Office Manager
Phone
(503) 416-6510

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X Primary
Vascular Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086S0129X
Colon & Rectal Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208C00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208G00000X

Addresses

Primary practice location

10000 SE Main St
Suite 311
Portland, OR 97216

Mailing address

10000 SE Main St Ste 212
Portland, OR 97216-2442
Phone (503) 416-6510

Other names 2

  • Bridgetown Surgical Clinic Doing business as
  • Healthcare Specialists NW P.C. Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040226001071 OR Part B Supplier - Clinic/Group Practice 1658267489 Receives reassigned benefits from 1 practitioner
2 other NPIs on this enrollment
Practice locations: Portland, OR

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

10000 SE Main St
Ste 311
Portland, OR 97216
Phone (503) 257-0748

10000 SE Main St
Ste 212
Portland, OR 97216
Phone (503) 251-6362

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1143417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1124088679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10000 SE MAIN ST STE 212",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972162442",
            "telephone_number": "503-416-6510",
            "fax_number": "503-416-6529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10000 SE MAIN ST",
            "address_2": "SUITE 311",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97216",
            "telephone_number": "503-257-0748",
            "fax_number": "503-255-0526"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIDGETOWN MEDICAL GROUP P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-27",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "SHAW",
        "authorized_official_first_name": "LINDSAY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "503-416-6510"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208C00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Colon & Rectal Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bridgetown Surgical Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Bridgetown Surgical Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Healthcare Specialists NW P.C.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jun 16, 2018; 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.