Individual provider Active NPI

John Takacs, DO

  • Family Medicine Physician
  • Portland, OR
National Provider Identifier
1215921374
Registry record updated Aug 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
DO15382 Issued in OR
Practice address
5909 SE Division St
Portland, OR 97206-1470
Phone
(503) 234-1531
Fax
(503) 234-2367
NPI assigned
Sep 6, 2005
Last updated
Aug 18, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 18, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X DO15382 OR Primary

Addresses

Primary practice location

5909 SE Division St
Portland, OR 97206-1470

Mailing address

5909 SE Division St
Portland, OR 97206-1470
Phone (503) 234-1531

Other identifiers 2

IdentifierTypeStateIssuer
048825002OtherORBCBSO
075562MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
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.
Opted out of Medicare
Previously, effective Aug 1, 2014 through Aug 1, 2026

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
DO15382ORMDFamily Medicine Physician

NPI Registry JSON

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

{
    "created_epoch": "1125964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755475200000",
    "number": "1215921374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5909 SE DIVISION ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972061470",
            "telephone_number": "503-234-1531",
            "fax_number": "503-234-2367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5909 SE DIVISION ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972061470",
            "telephone_number": "503-234-1531",
            "fax_number": "503-234-2367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAKACS",
        "first_name": "JOHN",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-06",
        "last_updated": "2025-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "DO15382",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSO",
            "identifier": "048825002",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "075562",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.