Individual provider Active NPI

Johnny Nolan, DO

  • Internal Medicine Physician
  • Happy Valley, OR
National Provider Identifier
1215677653
Registry record updated Aug 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
DO226572 Issued in OR
Practice address
11211 SE 82ND Ave Ste Z
Happy Valley, OR 97086-7669
Phone
(971) 432-7555
NPI assigned
Apr 1, 2022
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 7, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X DO226572 OR Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

11211 SE 82ND Ave Ste Z
Happy Valley, OR 97086-7669

Mailing address

502 W Highland Blvd
Inverness, FL 34452-4720
Phone (352) 726-1551

Other practice location 1

502 W Highland Blvd
Inverness, FL 34452-4720
Phone (352) 726-1551

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250905004135 OR Practitioner - Internal Medicine 8628435989 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Kansas City University of Med & Biosciences, College of Osteo Med, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
The Vancouver Clinic Inc PSGroup PAC ID 3173436490, 580 clinicians

Practice addresses (Care Compare)

11211 SE 82ND Ave
Suite Z
Happy Valley, OR 97086-7669
Phone (360) 882-2778

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
DO226572ORMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Vancouver Clinic Inc PS CurrentSince Sep 9, 2025 Accepting new patients
The Vancouver Clinic Inc PS CurrentSince Sep 9, 2025 Accepting new patients
The Vancouver Clinic Inc PS Single Specialty CurrentSince Jan 28, 2026 Accepting new patients
The Vancouver Clinic Pharmacy Single Specialty Past Accepting new patients

Locations

11211 SE 82nd Ave
Ste Z
Happy Valley, OR 97086
Phone (971) 432-7555

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

Interoperability endpoints

  • Direct secure messaging: jnolan27176@tvc-direct.org
  • Direct secure messaging: johnny.nolan@hca4.eclinicaldirectplus.com

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": "1648771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754524800000",
    "number": "1215677653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "502 W HIGHLAND BLVD",
            "city": "INVERNESS",
            "state": "FL",
            "postal_code": "344524720",
            "telephone_number": "352-726-1551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11211 SE 82ND AVE STE Z",
            "city": "HAPPY VALLEY",
            "state": "OR",
            "postal_code": "970867669",
            "telephone_number": "971-432-7555"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "502 W Highland Blvd",
            "address_purpose": "LOCATION",
            "city": "Inverness",
            "state": "FL",
            "postal_code": "344524720",
            "country_code": "US",
            "telephone_number": "352-726-1551",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NOLAN",
        "first_name": "JOHNNY",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-04-01",
        "last_updated": "2025-08-07",
        "certification_date": "2025-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "DO226572",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Happy Valley, OR

Sources for this page

Verify at the official NPI Registry.