Providence Health & Services - Oregon

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

PROVIDENCE HEALTH & SERVICES - OREGON

Doing business as

Providence Medical Group
Providence Medical Group Canby Family Medicine

Practice address

200 S Hazel Dell Way
Canby, OR 97013-7829

Phone

(503) 263-9500

Fax

(503) 263-1383

NPI assigned

Oct 25, 2012

Last updated

Jun 20, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Donald W Anderson Jr.

Title

Assistant Secretary of Enrollments

Phone

(425) 358-9786

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 2

• PROVIDENCE MEDICAL GROUP Doing business as
• Providence Medical Group Canby Family Medicine Doing business as

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jacob Abraham, M.D.

  • Advanced Heart Failure and Transplant Cardiology Physician
  • Portland, OR
  • NPI 1548223381
  NPD
• Amy Marie Anderson, PA-C

  • Physician Assistant
  • Hillsboro, OR
  • NPI 1235653288
  NPD
• Robert J Litt, M.D.

  • Cardiovascular Disease Physician
  • Portland, OR
  • NPI 1467444331
  NPD
• Zachary Aaron Miller, PA-C

  • Physician Assistant
  • Syracuse, NY
  • NPI 1861984239
  NPD

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

{
    "created_epoch": "1351123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750377600000",
    "number": "1184977233",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 S HAZEL DELL WAY",
            "city": "CANBY",
            "state": "OR",
            "postal_code": "970137829",
            "telephone_number": "503-263-9500",
            "fax_number": "503-263-1383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH & SERVICES - OREGON",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-25",
        "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": "W",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY OF ENROLLMENTS",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500653371",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PROVIDENCE MEDICAL GROUP",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Providence Medical Group Canby Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Porchlight Custom Counseling LLC
• Emily Porter, CPM
• Ira Povey, DDS
• Pregnancy Care Centers Inc
• Prime Perfusion Inc
• Providence Health & Services - Oregon (Providence Medical Group)
• R L Perez, PC (New Foundation Inner Health)
• Lauren Radakovich, MA
• Shannon Rants, LPC
• Erin K Reed

• Family Medicine Physician in Canby, OR
• Providers in Canby, OR by specialty
• Family 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.