Providence Health & Services - Oregon

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

PROVIDENCE HEALTH & SERVICES - OREGON

Practice address

16180 SE Sunnyside Rd
Suite 102
Happy Valley, OR 97015-6302

Phone

(503) 582-4975

Fax

(503) 582-4999

NPI assigned

Nov 3, 2009

Organization subpart

No

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

Authorized official

Name

Donald Wayne Anderson Jr.

Title

Assistant Secretary Enrollments

Phone

(425) 358-9786

Specialties & licenses 6

Addresses

Other names 2

• PROVIDENCE MEDICAL GROUP Doing business as
• Providence Medical Group Happy Valley Immediate Care Doing business as

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tracy Bazan, MD

  • Neuromuscular Medicine (Psychiatry & Neurology) Physician
  • Portland, OR
  • NPI 1487073789
  NPD
• Dianne C Eardley, MD

  • Internal Medicine Physician
  • Portland, OR
  • NPI 1740210434

  Internal Medicine

  NPD
• Sukhraj K Jhooty, M.D.

  • Hospitalist Physician
  • Portland, OR
  • NPI 1417912189

  Internal Medicine

  NPD
• Wai L Lee, MD

  • Rheumatology Physician
  • Portland, OR
  • NPI 1881623254
  NPD
• Deborah J Murphy, M.D.

  • Family Medicine Physician
  • Portland, OR
  • NPI 1073588471

  Family Medicine

  NPD
• Tajwar Taher, MD

  • Family Medicine Physician
  • McMinnville, OR
  • NPI 1366024242

  Family Medicine

  NPD
• Muhammad Riaz, M.D

  • Family Medicine Physician
  • Longview, WA
  • NPI 1053610493

  Family Medicine

  NPD

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

{
    "created_epoch": "1257206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750377600000",
    "number": "1245567809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31001 - 4180",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911104180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16180 SE SUNNYSIDE RD",
            "address_2": "SUITE 102",
            "city": "HAPPY VALLEY",
            "state": "OR",
            "postal_code": "970156302",
            "telephone_number": "503-582-4975",
            "fax_number": "503-582-4999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH & SERVICES - OREGON",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-03",
        "last_updated": "2025-06-20",
        "certification_date": "2025-06-20",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY ENROLLMENTS",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PROVIDENCE MEDICAL GROUP",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Providence Medical Group Happy Valley Immediate Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in Happy Valley, OR
• Internal Medicine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2025; 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.