NPIMap

Organization Active NPI

Dr. Sanderson and Associates, LLC

  • Psychologist
  • Tigard, OR
National Provider Identifier
1124652821
Registry record updated Sep 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
DR. SANDERSON AND ASSOCIATES, LLC
Practice address
11845 SW Greenburg Rd Ste 210
Tigard, OR 97223-6464
Phone
(971) 264-0879
Fax
(971) 266-4521
NPI assigned
Mar 3, 2020
Last updated
Sep 18, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2024

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

Authorized official

Name
Dr. Tara Sanderson, PSYD, MBANPI 1841469616
Title
Owner
Phone
(971) 264-0879

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
Psychologist 103T00000X Primary

Addresses

Primary practice location

11845 SW Greenburg Rd Ste 210
Tigard, OR 97223-6464

Mailing address

901 N Brutscher St # D141
Newberg, OR 97132-6096
Phone (971) 264-0879

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241029003468 OR Part B Supplier - Clinic/Group Practice 1759814726 Receives reassigned benefits from 4 practitioners
Practice locations: Tigard, OR

National Provider Directory

National Provider Directory

Locations

901 N Brutscher St
#D141
Newberg, OR 97132

901 N Brutscher St
Ste D141
Newberg, OR 97132

11845 SW Greenburg Rd
Ste 210
Tigard, OR 97223
Phone (971) 264-0879

Practitioners & affiliated clinicians

Practitioners 26

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1583193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726617600000",
    "number": "1124652821",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 N BRUTSCHER ST # D141",
            "city": "NEWBERG",
            "state": "OR",
            "postal_code": "971326096",
            "telephone_number": "971-264-0879",
            "fax_number": "971-266-4521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11845 SW GREENBURG RD STE 210",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972236464",
            "telephone_number": "971-264-0879",
            "fax_number": "971-266-4521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. SANDERSON AND ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-03",
        "last_updated": "2024-09-18",
        "certification_date": "2024-09-18",
        "status": "A",
        "authorized_official_last_name": "SANDERSON",
        "authorized_official_first_name": "TARA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "971-264-0879",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD, MBA"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tigard, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2024; 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.