Individual provider Active NPI

Douglas Lee Beal, ANP

  • Adult Health Nurse Practitioner
  • Portland, OR
National Provider Identifier
1164530747
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
087003278N3 Issued in OR
Practice address
3550 N Interstate Ave
Portland, OR 97227-1196
Phone
(503) 285-9321
NPI assigned
Aug 25, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 087003278N3 OR Primary

Addresses

Primary practice location

3550 N Interstate Ave
Portland, OR 97227-1196

Mailing address

6342 NE 32ND PL
Portland, OR 97211-6631

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, WA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20071227000546 OR Practitioner - Nurse Practitioner 3577643899 Reassigns benefits to 1 organization
I20110914000178 WA Practitioner - Nurse Practitioner 3577643899 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
087003278N3ORMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Kaiser Foundation Health Plan of the Northwest Current Accepting new patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Aug 2, 2011 Accepting new patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Aug 2, 2011 Accepting new patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Mar 29, 2023 Accepting new patients

Locations

10100 SE Sunnyside Rd
Clackamas, OR 97015
Phone (503) 571-2946

3550 N Interstate Ave
Portland, OR 97227
Phone (503) 285-9321

7201 N Interstate Ave
Portland, OR 97217
Phone (503) 240-4051

3550 N Interstate Ave
Ofc
Portland, OR 97227
Phone (503) 285-9321

2400 Lancaster Dr NE
Salem, OR 97305
Phone (503) 361-5400

1230 7th Ave
Longview, WA 98632
Phone (360) 575-4801

7101 NE 137th Ave
Vancouver, WA 98682
Phone (360) 418-6000

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1164530747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6342 NE 32ND PL",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972116631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3550 N INTERSTATE AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972271196",
            "telephone_number": "503-285-9321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEAL",
        "first_name": "DOUGLAS",
        "middle_name": "LEE",
        "credential": "ANP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "OR",
            "license": "087003278N3",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.