Providence Health & Services - Oregon

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

PROVIDENCE HEALTH & SERVICES - OREGON

Practice address

16770 SW Edy Rd
Suite 102
Sherwood, OR 97140-9679

Phone

(503) 216-9600

Fax

(503) 216-9650

NPI assigned

Sep 13, 2006

Organization subpart

No

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

Authorized official

Name

Donald Wayne Anderson Jr.

Title

Assistant Secretary of Enrollments

Phone

(425) 358-9786

Specialties & licenses 6

Addresses

Other identifiers 2

Other names 2

• PROVIDENCE MEDICAL GROUP Doing business as
• Providence Medical Group Sherwood Doing business as

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Locations (25 of 60)

Practitioners 749

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

• Rebecca M Combs, PA-C

  • Physician Assistant
  • Portland, OR
  • NPI 1184074833
  NPD
• Maria Luisa Constante, MD

  • Family Medicine Physician
  • Portland, OR
  • NPI 1104856285
  NPD
• Crispin Henry Davies, MD

  • Cardiovascular Disease Physician
  • Portland, OR
  • NPI 1982610481
  NPD
• Jennifer Goodrich, AGACNP-BC

  • Gerontology Nurse Practitioner
  • Portland, OR
  • NPI 1174002976
  NPD
• Benjamin Hearty, PA-C

  • Physician Assistant
  • Clackamas, OR
  • NPI 1366890386
  NPD
• Vihangi Hindagolla, DO

  • Family Medicine Physician
  • Tigard, OR
  • NPI 1346621232
  NPD
• Jessica N James, FNP

  • Family Nurse Practitioner
  • Portland, OR
  • NPI 1326471616
  NPD
• Dipesh K C Ghimire, MD

  • Hospitalist Physician
  • Portland, OR
  • NPI 1295106169

  Internal Medicine

  NPD
• Shelby Delia Meyer, MD

  • Internal Medicine Physician
  • Portland, OR
  • NPI 1467101022
  NPD
• Laura D. Milner, PSY. D

  • Clinical Psychologist
  • Happy Valley, OR
  • NPI 1144560582
  NPD
• Jillian Elaine Pennington, FNP

  • Family Nurse Practitioner
  • Newberg, OR
  • NPI 1225910649
  NPD
• Donna Lynn Perfetti, O.T.R./L

  • Occupational Therapist
  • Portland, OR
  • NPI 1881770105
  NPD

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

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750377600000",
    "number": "1184729329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31001 - 4180",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911104180",
            "telephone_number": "503-215-6494",
            "fax_number": "503-215-6644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16770 SW EDY RD",
            "address_2": "SUITE 102",
            "city": "SHERWOOD",
            "state": "OR",
            "postal_code": "971409679",
            "telephone_number": "503-216-9600",
            "fax_number": "503-216-9650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH & SERVICES - OREGON",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-13",
        "last_updated": "2025-06-20",
        "certification_date": "2025-06-20",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY OF ENROLLMENTS",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0805X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Geriatric Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "022851",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500400324",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PROVIDENCE MEDICAL GROUP",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Providence Medical Group Sherwood",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Premere Rehab LLC
• Premere Rehab LLC
• Dominic Richard Prime, PHD
• Progress Dental LLC
• Providence Health & Services - Oregon
• Providence Health & Services-Oregon Newberg Medical Center
• Jennifer Pumpelly, MASSAGE THERAPIST
• Thomas Louis Ratliff, DDS
• Renal Treatment Centers West Inc
• Christina Rendel

• Internal Medicine Physician in Sherwood, OR
• Providers in Sherwood, OR by specialty
• Internal Medicine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.