NPIMap

Organization Active NPI

Credena Health LLC

  • Community/Retail Pharmacy
  • Portland, OR
National Provider Identifier
1225190408
Registry record updated Dec 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
CREDENA HEALTH LLC
Practice address
9155 SW Barnes Rd Ste 102
Portland, OR 97225-6625
Phone
(503) 216-2630
Fax
(503) 216-2637
NPI assigned
Dec 14, 2006
Last updated
Dec 7, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2023

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

Authorized official

Name
Mike Skafi
Title
Avp/Secretary
Phone
(575) 650-3396

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic Pharmacy 3336C0002X
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

9155 SW Barnes Rd Ste 102
Portland, OR 97225-6625

Mailing address

PO Box 2704
Portland, OR 97208-2704

Other names 1

  • Credena Health Pharmacy St Vincent Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20151116001315 OR Part B Supplier - Pharmacy 7810207206 5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Hillsboro, OR; Portland, OR
O20191115001975 OR Part B Supplier - Mass Immunization (Roster Biller Only) 7810207206 4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Hillsboro, OR; Portland, OR
O20200813000869 OR DME Supplier - Pharmacy 7810207206 Practice locations: Portland, OR

Other NPIs with the same Medicare PAC ID 19

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 19

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
38D2216207Credena Health Pharmacy St Vincent9155 SW Barnes Mob 2, Floor 1, Suite 102, Portland, OR 97225Certificate of waiverMar 9, 2027

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Credena Health Pharmacy St Vincent9155 SW Barnes Rd, Portland, OR 97225-6625(503) 216-2630 Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs Accepts assignmentParticipating since Oct 22, 2015

National Provider Directory

National Provider Directory
Tax ID family
Credena Health LLC21 organizations share this tax ID, including this one

Other organizations with this tax ID 20

Organizations that report the same tax identification number in the National Provider Directory.

View all 20

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1166054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701907200000",
    "number": "1225190408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2704",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972082704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9155 SW BARNES RD STE 102",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972256625",
            "telephone_number": "503-216-2630",
            "fax_number": "503-216-2637"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREDENA HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-14",
        "last_updated": "2023-12-07",
        "certification_date": "2023-12-04",
        "status": "A",
        "authorized_official_last_name": "SKAFI",
        "authorized_official_first_name": "MIKE",
        "authorized_official_title_or_position": "AVP/SECRETARY",
        "authorized_official_telephone_number": "575-650-3396"
    },
    "taxonomies": [
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Credena Health Pharmacy St Vincent",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.