NPIMap

Organization Active NPI

Premise Health of Oregon Medical P C

  • Multi-Specialty Clinic/Center
  • Portland, OR
National Provider Identifier
1134895410
Registry record updated Oct 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
PREMISE HEALTH OF OREGON MEDICAL P C
Practice address
6936 N Fathom St
Portland, OR 97217-3928
Phone
(971) 717-6307
Fax
(971) 717-6492
NPI assigned
Aug 18, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2022

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

Authorized official

Name
Jonathan Leizman
Title
President
Phone
(216) 479-9063

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

6936 N Fathom St
Portland, OR 97217-3928

Mailing address

5500 Maryland Way
Brentwood, TN 37027-7048

Other names 1

  • DTNA - Portland Occ Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Deschutes Juvenile Detention Center Clinic9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Locations

6936 N Fathom St
Portland, OR 97217
Phone (503) 745-7138

NPI Registry JSON

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

{
    "created_epoch": "1629244800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665619200000",
    "number": "1134895410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5500 MARYLAND WAY",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6936 N FATHOM ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972173928",
            "telephone_number": "971-717-6307",
            "fax_number": "971-717-6492"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMISE HEALTH OF OREGON MEDICAL P C",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-18",
        "last_updated": "2022-10-13",
        "certification_date": "2022-10-13",
        "status": "A",
        "authorized_official_last_name": "LEIZMAN",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "216-479-9063"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DTNA - Portland Occ",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "DTNA - Portland Occ",
            "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 Oct 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.