Individual provider Active NPI

Shirin R. Sukumar, M.D.

  • Geriatric Medicine (Internal Medicine) Physician
  • Portland, OR
National Provider Identifier
1245278993
Registry record updated Aug 27, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
MD23728 Issued in OR
Practice address
1200 NW 23Rd Ave
Legacy Clinic Good Samaritan
Portland, OR 97210-2906
Phone
(503) 413-7074
Fax
(503) 413-6769
NPI assigned
Jun 3, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2007

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD23728 OR
Geriatric Medicine (Internal Medicine) Physician 207RG0300X MD23728 OR Primary

Addresses

Primary practice location

1200 NW 23Rd Ave
Legacy Clinic Good Samaritan
Portland, OR 97210-2906

Mailing address

1200 NW 23Rd Ave
Legacy Clinic Good Samaritan
Portland, OR 97210-2906
Phone (503) 413-7074

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040517000023 OR Practitioner - Geriatric MedicinePractitioner - Internal Medicine 3971593427 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Geriatric Medicine
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Legacy Clinics LLCGroup PAC ID 0244144004, 714 clinicians

Practice addresses (Care Compare)

1130 NW 22ND Ave
Suite 220
Portland, OR 97210-2969
Phone (503) 413-8988

1200 NW 23Rd Ave
Portland, OR 97210-2906
Phone (503) 413-7074

6485 SW Borland Rd
Suite F
Tualatin, OR 97062-9762
Phone (503) 413-8018

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.62 of 100Reported as apm
Quality
77.21
Promoting interoperability
99.06
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD23728ORMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Legacy Good Samaritan Hospital and Medical Center CurrentSince Dec 11, 2006 Accepting new patients
Legacy Emanuel Hospital & Health Center CurrentSince Sep 1, 2014 Accepting new patients
Legacy Good Samaritan Hospital and Medical Center CurrentSince Dec 11, 2006 Accepting new patients
Legacy Clinics LLC Internal Medicine CurrentSince Dec 11, 2006 Accepting new patients
Legacy Good Samaritan Hospital and Medical Center Current Accepting new patients
Legacy Emanuel Hospital & Health Center CurrentSince Sep 1, 2014 Accepting new patients
Legacy Emanuel Hospital & Health Center Current Accepting new patients

Locations

15 N Morris St
Ste 580
Portland, OR 97227
Phone (503) 528-0704

1200 NW 23rd Ave
Portland, OR 97210
Phone (503) 413-7074

2800 N Vancouver Ave
Ste 201
Portland, OR 97227
Phone (503) 276-9000

1130 NW 22nd Ave
Ste 220
Portland, OR 97210
Phone (503) 413-4134

2801 N Gantenbein Ave
Portland, OR 97227
Phone (503) 413-2200

6485 SW Borland Rd
Ste F
Tualatin, OR 97062
Phone (503) 413-3650

Interoperability endpoints

  • Direct secure messaging: ssukumar14429@direct.lhs.org

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1149292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1188172800000",
    "number": "1245278993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 NW 23RD AVE",
            "address_2": "LEGACY CLINIC GOOD SAMARITAN",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972102906",
            "telephone_number": "503-413-7074",
            "fax_number": "503-413-6769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 NW 23RD AVE",
            "address_2": "LEGACY CLINIC GOOD SAMARITAN",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972102906",
            "telephone_number": "503-413-7074",
            "fax_number": "503-413-6769"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUKUMAR",
        "first_name": "SHIRIN",
        "middle_name": "R.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-03",
        "last_updated": "2007-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "MD23728",
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "OR",
            "license": "MD23728",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.