Individual provider Active NPI

Susan Elizabeth Passarelli, NP

  • Family Nurse Practitioner
  • Portland, OR
National Provider Identifier
1154842805
Registry record updated Dec 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
201704699NP Issued in OR
Practice address
5005 NE Sandy Blvd
Portland, OR 97213-1941
Phone
(503) 233-6940
Fax
(503) 236-2676
NPI assigned
Jul 3, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 201704699NP OR Primary

Addresses

Primary practice location

5005 NE Sandy Blvd
Portland, OR 97213-1941

Mailing address

800 SW 13TH Ave
Portland, OR 97205-1999
Phone (503) 221-0161

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171211001350 OR Practitioner - Nurse Practitioner 1456619980 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Portland ClinicGroup PAC ID 8224942867, 93 clinicians

Practice addresses (Care Compare)

5005 NE Sandy Blvd
Portland, OR 97213-1941
Phone (503) 233-6940

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
201704699NPORMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Portland Clinic CurrentSince Dec 1, 2021 Accepting new patients

Locations

800 SW 13th Ave
Portland, OR 97205
Phone (503) 221-0161

5005 NE Sandy Blvd
Portland, OR 97213
Phone (503) 233-6940

9250 SW Hall Blvd
Tigard, OR 97223
Phone (503) 221-0161

Interoperability endpoints

  • Direct secure messaging: spassarelli32087@theportlandclinic.gardenplot.direct-ci.com

Organizations & group practices 1

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 2

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": "1499040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638835200000",
    "number": "1154842805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 SW 13TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972051999",
            "telephone_number": "503-221-0161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5005 NE SANDY BLVD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972131941",
            "telephone_number": "503-233-6940",
            "fax_number": "503-236-2676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PASSARELLI",
        "first_name": "SUSAN",
        "middle_name": "ELIZABETH",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-03",
        "last_updated": "2021-12-07",
        "certification_date": "2021-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OR",
            "license": "201704699NP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.