NPIMap

Organization Active NPI

Providence Health & Services - Oregon

Doing business as Providence St Vincent Department of Medicine

  • Clinic/Center
  • Portland, OR
National Provider Identifier
1235259532
Registry record updated Jun 20, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
PROVIDENCE HEALTH & SERVICES - OREGON
Doing business as
Providence St Vincent Department of Medicine
Practice address
9205 SW Barnes Rd
Suite 20
Portland, OR 97225-6603
Phone
(503) 216-2229
Fax
(503) 216-4041
NPI assigned
Mar 30, 2007
Last updated
Jun 20, 2013By the provider in NPPES
Organization subpart
Yes
Parent organization
PROV ST. VINCENT MEDICAL CTRAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 20, 2013

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

Authorized official

Name
Shelly Handkins
Title
Chief Finance Officer
Phone
(503) 216-2229

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

9205 SW Barnes Rd
Suite 20
Portland, OR 97225-6603

Mailing address

PO Box 3158
Portland, OR 97208-3158

Other names 1

  • PROVIDENCE ST VINCENT DEPARTMENT OF MEDICINE Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031117000153 OR Part B Supplier - Clinic/Group Practice 9335057447 Receives reassigned benefits from 790 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Portland, OR

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory
Tax ID family
St Vincent Medical Phar9 organizations share this tax ID, including this one
Part of
St Vincent Medical Phar

Other organizations with this tax ID 8

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

Practitioners & affiliated clinicians

Practitioners 5

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": "1175212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1371686400000",
    "number": "1235259532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3158",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9205 SW BARNES RD",
            "address_2": "SUITE 20",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972256603",
            "telephone_number": "503-216-2229",
            "fax_number": "503-216-4041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH & SERVICES - OREGON",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROV ST. VINCENT MEDICAL CTR",
        "enumeration_date": "2007-03-30",
        "last_updated": "2013-06-20",
        "status": "A",
        "authorized_official_last_name": "HANDKINS",
        "authorized_official_first_name": "SHELLY",
        "authorized_official_title_or_position": "CHIEF FINANCE OFFICER",
        "authorized_official_telephone_number": "503-216-2229"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PROVIDENCE ST VINCENT DEPARTMENT OF MEDICINE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jun 20, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.