Active NPI
Ignatius Gerardo Eleazar Zarraga, M.D.
- Internal Medicine Physician
- Portland, OR
National Provider Identifier
1235252313
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- MD150575
- Practice address
- 3181 SW Sam Jackson Park Rd
Portland, OR 97239-3011 - Phone
- (503) 494-8750
- Fax
- (503) 494-8550
- NPI assigned
- Apr 6, 2007
- Last updated
- May 3, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | MD150575 | OR | Primary |
| Cardiovascular Disease Physician | 207RC0000X | MD150575 | OR | |
| Clinical Cardiac Electrophysiology Physician | 207RC0001X | MD150575 | OR |
Addresses
Primary practice location
3181 SW Sam Jackson Park Rd
Portland, OR 97239-3011
Mailing address
3181 SW Sam Jackson Park Rd
Portland, OR 97239-3011
Phone (503) 494-8750
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8X6782 | Other | TX | BCBS |
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110825000541 | OR | Order and Referring Only - Cardiovascular Disease (Cardiology) | 6204925167 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD150575 | OR | MD | Clinical Cardiac Electrophysiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175817600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1272844800000",
"number": "1235252313",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3181 SW SAM JACKSON PARK RD",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972393011",
"telephone_number": "503-494-8750",
"fax_number": "503-494-8550"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3181 SW SAM JACKSON PARK RD",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972393011",
"telephone_number": "503-494-8750",
"fax_number": "503-494-8550"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ZARRAGA",
"first_name": "IGNATIUS GERARDO",
"middle_name": "ELEAZAR",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-06",
"last_updated": "2010-05-03",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "OR",
"license": "MD150575",
"primary": true
},
{
"code": "207RC0000X",
"taxonomy_group": "",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": "OR",
"license": "MD150575",
"primary": false
},
{
"code": "207RC0001X",
"taxonomy_group": "",
"desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
"state": "OR",
"license": "MD150575",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "8X6782",
"state": "TX"
}
],
"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 May 3, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.