NPIMap

Individual provider Active NPI

Rahwa Shumet Ghebremichael, MD

  • Internal Medicine Physician
  • Vancouver, WA
National Provider Identifier
1184071813
Registry record updated Dec 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD200050 Issued in OR
Practice address
709 NE 136TH Ave
Vancouver, WA 98684-6919
Phone
(360) 882-2778
NPI assigned
May 23, 2016
Last updated
Dec 12, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD61087337 WA
Student in an Organized Health Care Education/Training Program 390200000X OR
Internal Medicine Physician 207R00000X MD200050 OR Primary

Addresses

Primary practice location

709 NE 136TH Ave
Vancouver, WA 98684-6919

Mailing address

PO Box 4825
Portland, OR 97208-4825
Phone (360) 882-2778

Other identifiers 1

IdentifierTypeStateIssuer
2165730MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, OR2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20201210001049 WA Practitioner - Internal Medicine 7911299714 Reassigns benefits to 1 organization
I20231227002839 OR Practitioner - Internal Medicine 7911299714 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Oregon Health Sciences University School of Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

2801 N Gantenbein Ave
Portland, OR 97227-1623
Phone (503) 413-2042

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD200050ORMDInternal Medicine Physician
MD61087337WAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Vancouver Clinic Inc PS CurrentSince Jan 11, 2021 Accepting new patients
Legacy Emanuel Hospital & Health Center CurrentSince Dec 12, 2023 Accepting new patients
Legacy Emanuel Hospital & Health Center CurrentSince Dec 12, 2023 Accepting new patients
Legacy Emanuel Hospital & Health Center Current Accepting new patients
The Vancouver Clinic Inc PS Internal Medicine CurrentSince Jan 11, 2021 Accepting new patients

Locations

1600 NE Broadway St
Portland, OR 97232
Phone (503) 525-7599

1919 NW Lovejoy St
Portland, OR 97209
Phone (503) 415-5600

2801 N Gantenbein Ave
Portland, OR 97227
Phone (503) 413-2200

700 NE 87th Ave
Vancouver, WA 98664
Phone (360) 397-1500

709 NE 136th Ave
Vancouver, WA 98684

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 11

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": "1463961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702339200000",
    "number": "1184071813",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4825",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972084825",
            "telephone_number": "360-882-2778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "709 NE 136TH AVE",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986846919",
            "telephone_number": "360-882-2778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GHEBREMICHAEL",
        "first_name": "RAHWA",
        "middle_name": "SHUMET",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-05-23",
        "last_updated": "2023-12-12",
        "certification_date": "2023-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "MD61087337",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "OR",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "MD200050",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2165730",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vancouver, WA

Sources for this page

Verify at the official NPI Registry.