NPIMap

Organization Active NPI

Pacific Premier Group, PC

  • Psychiatry Physician
  • Portland, OR
National Provider Identifier
1225797350
Registry record updated Dec 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
PACIFIC PREMIER GROUP, PC
Practice address
4730 S Macadam Ave Ste 201
Portland, OR 97239-6417
Phone
(503) 278-5665
Fax
(503) 241-2367
NPI assigned
Dec 16, 2021
Last updated
Dec 16, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2021

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

Authorized official

Name
Carmen Hepner-Hall
Title
Director of Operations
Phone
(971) 801-6448

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101Y00000X
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X Primary

Addresses

Primary practice location

4730 S Macadam Ave Ste 201
Portland, OR 97239-6417

Mailing address

4730 S Macadam Ave Ste 201
Portland, OR 97239-6417
Phone (503) 278-5665

National Provider Directory

National Provider Directory

Locations

4730 S Macadam Ave
Ste 201
Portland, OR 97239
Phone (503) 278-5665

Practitioners & affiliated clinicians

Practitioners 6

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": "1639612800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639612800000",
    "number": "1225797350",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4730 S MACADAM AVE STE 201",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972396417",
            "telephone_number": "503-278-5665",
            "fax_number": "503-241-2367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4730 S MACADAM AVE STE 201",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972396417",
            "telephone_number": "503-278-5665",
            "fax_number": "503-241-2367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC PREMIER GROUP, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-16",
        "last_updated": "2021-12-16",
        "certification_date": "2021-12-16",
        "status": "A",
        "authorized_official_last_name": "HEPNER-HALL",
        "authorized_official_first_name": "CARMEN",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "971-801-6448"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.