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Providence Health & Services Oregon

Organization Active NPI Internal Medicine Physician · Portland, OR

NPI 1164623401 · NPPES record last updated Jun 20, 2025

Key facts

NPI
1164623401
Entity type
Organization (NPI type 2)
Primary specialty
Internal Medicine Physician 207R00000X
Legal business name
PROVIDENCE HEALTH & SERVICES OREGON
Practice address
4400 NE Halsey St
Portland, OR 97213-1545
Phone
(503) 893-6524
NPI assigned
May 31, 2007
Organization subpart
No

Authorized official

Name
Donald Wayne Anderson Jr.
Title
Assistant Secretary of Enrollments
Phone
(425) 358-9786

Other NPIs on the same Medicare enrollment 14

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

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Practitioners 1,445

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

View all 1,445

Medicare participation

Medicare fee-for-service enrollment
Enrolled (24 enrollments) in OR, WA, CO, AK, CA, MI, MT, FL, NV, MO, DC, TX, NY, HI, ID, AZ, MN, IL, WI, NE, UT, NC, NJ, TN

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20031106000652 OR Part B Supplier - Clinic/Group Practice 0648183608 Receives reassigned benefits from 1,658 practitioners
This NPI is an additional NPI on the enrollment
O20080630000201 WA Part B Supplier - Clinic/Group Practice 0648183608 Receives reassigned benefits from 77 practitioners
15 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
O20181217001928 CO Part B Supplier - Clinic/Group Practice 0648183608 Receives reassigned benefits from 1 practitioner
Practice locations: Frisco, CO
O20190131000428 AK Part B Supplier - Clinic/Group Practice 0648183608 Receives reassigned benefits from 5 practitioners
Practice locations: Anchorage, AK
O20190208002324 CA Part B Supplier - Clinic/Group Practice 0648183608 Receives reassigned benefits from 15 practitioners
Practice locations: Walnut Creek, CA; Truckee, CA; San Francisco, CA; San Diego, CA; Glendale, CA; Riverside, CA; Redlands, CA; Los Angeles, CA…
O20190814001020 MI Part B Supplier - Clinic/Group Practice 0648183608 Receives reassigned benefits from 4 practitioners
Practice locations: Saint Clair Shores, MI; Shelby, MI; Hudsonville, MI; Hart, MI; Ada, MI; Ludington, MI
O20200327001992 MT Part B Supplier - Clinic/Group Practice 0648183608 Receives reassigned benefits from 7 practitioners
Practice locations: Missoula, MT; Lolo, MT
O20200825000088 FL Part B Supplier - Clinic/Group Practice 0648183608 Receives reassigned benefits from 1 practitioner
Practice locations: Miami, FL
O20200826002266 NV Part B Supplier - Clinic/Group Practice 0648183608 Receives reassigned benefits from 4 practitioners
Practice locations: Reno, NV
O20201023002706 MO Part B Supplier - Clinic/Group Practice 0648183608 Receives reassigned benefits from 1 practitioner
Practice locations: Manchester, MO
O20210519002348 DC Part B Supplier - Clinic/Group Practice 0648183608 Receives reassigned benefits from 1 practitioner
Practice locations: Bowie, MD
O20210920001288 TX Part B Supplier - Clinic/Group Practice 0648183608 Receives reassigned benefits from 6 practitioners
Practice locations: Westlake, TX; Irving, TX; Houston, TX; Frisco, TX; Friendswood, TX
O20211105002351 NY Part B Supplier - Clinic/Group Practice 0648183608 Receives reassigned benefits from 3 practitioners
Practice locations: Brooklyn, NY; White Plains, NY; Syosset, NY
O20211109000906 HI Part B Supplier - Clinic/Group Practice 0648183608 Receives reassigned benefits from 1 practitioner
Practice locations: Honolulu, HI
O20220516000248 ID Part B Supplier - Clinic/Group Practice 0648183608 Receives reassigned benefits from 2 practitioners
Practice locations: Boise, ID; Kuna, ID
O20230215002913 AZ Part B Supplier - Clinic/Group Practice 0648183608 Receives reassigned benefits from 1 practitioner
Practice locations: Green Valley, AZ
O20230809001911 MN Part B Supplier - Clinic/Group Practice 0648183608 Receives reassigned benefits from 1 practitioner
Practice locations: Minneapolis, MN
O20240802003387 IL Part B Supplier - Clinic/Group Practice 0648183608 Receives reassigned benefits from 3 practitioners
Practice locations: Oak Brook, IL; Oak Park, IL; Park Ridge, IL
O20241008004406 WI Part B Supplier - Clinic/Group Practice 0648183608 Receives reassigned benefits from 1 practitioner
Practice locations: Williams Bay, WI
O20241015000805 NE Part B Supplier - Clinic/Group Practice 0648183608 Receives reassigned benefits from 1 practitioner
Practice locations: Elkhorn, NE
O20250429002938 UT Part B Supplier - Clinic/Group Practice 0648183608 Receives reassigned benefits from 2 practitioners
Practice locations: St George, UT; Hurricane, UT
O20250630000871 NC Part B Supplier - Clinic/Group Practice 0648183608 Receives reassigned benefits from 1 practitioner
Practice locations: Huntersville, NC
O20251031000928 NJ Part B Supplier - Clinic/Group Practice 0648183608 Receives reassigned benefits from 1 practitioner
Practice locations: Hillside, NJ
O20251031002865 TN Part B Supplier - Clinic/Group Practice 0648183608 Receives reassigned benefits from 1 practitioner
Practice locations: Memphis, TN

National Provider Directory

Locations

501 S Buena Vista St
#1
Burbank, CA 91505
Phone (818) 847-4145

4400 NE Halsey St
Portland, OR 97213
Phone (503) 215-0750

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker
Group: 193200000X MULTI-SPECIALTY GROUP		 104100000X
Internal Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207R00000X Yes
Clinic/Center 261Q00000X

Addresses

Primary practice location

4400 NE Halsey St
Portland, OR 97213-1545

Mailing address

PO Box 31001 - 4180
Pasadena, CA 91110-4180

Other names

  • Providence Medical Group Doing business as

Other providers in Portland, OR

All providers in Portland, OR · Internal Medicine Physician in Oregon

Sources for this page

Verify at the official NPI Registry.