NPIMap

Individual provider Active NPI

Bruce Fernstrom, PA-C

  • Surgical Physician Assistant
  • Portland, OR
National Provider Identifier
1255329967
Registry record updated Jul 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA00805 Issued in OR
Practice address
501 N Graham St Ste 420
Portland, OR 97227-2006
Phone
(503) 288-7303
Fax
(503) 288-3806
NPI assigned
Oct 7, 2005
Last updated
Jul 28, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA00805 OR
Surgical Physician Assistant 363AS0400X PA00805 OR Primary

Addresses

Primary practice location

501 N Graham St Ste 420
Portland, OR 97227-2006

Mailing address

541 NE 20TH Ave Ste 225
Portland, OR 97232-2895
Phone (503) 963-2801

Other practice location 1

1130 NW 22nd Ave Ste 400
Portland, OR 97210-2971
Phone (503) 413-6722

Other practice location 2

19250 SW 65th Ave Ste 235
Tualatin, OR 97062-7745
Phone (503) 692-4820

Other identifiers 1

IdentifierTypeStateIssuer
500600862MedicaidOR

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address cc_otoc_aua_urology_emanuel_front_desk_pool12223225@oc.providencedirect.org The Oregon Clinic PC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071221000200 OR Practitioner - Physician Assistant 9537259973 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
The Oregon Clinic, PCGroup PAC ID 2860390408, 353 clinicians

Practice addresses (Care Compare)

1015 NW 22ND Ave
Portland, OR 97210-3025
Phone (503) 413-7711

1130 NW 22ND Ave
Suite 400
Portland, OR 97210-2971
Phone (503) 413-6722

19250 SW 65TH Ave
Suite 235
Tualatin, OR 97062-7745
Phone (503) 692-4820

24900 SE Stark St
Suite 103
Gresham, OR 97030-3381
Phone (503) 288-7303

501 N Graham St
Suite 420
Portland, OR 97227-2006
Phone (503) 288-7303

5050 NE Hoyt
Suite 655
Portland, OR 97213-2990
Phone (503) 239-6673

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA00805ORMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Tuality Healthcare CurrentSince Jun 7, 2018 Accepting new patients
The Oregon Clinic PC CurrentSince Jul 1, 2015 Accepting new patients
Tuality Healthcare Current Accepting new patients
The Oregon Clinic, PC CurrentSince Jul 1, 2015 Accepting new patients
Tuality Healthcare CurrentSince Jun 7, 2018 Accepting new patients
Legacy Good Samaritan Hospital and Medical Center CurrentSince Jul 17, 2025 Accepting new patients
Tuality Medical Group LLC CurrentSince Jun 7, 2018 Accepting new patients
Legacy Good Samaritan Hospital and Medical Center CurrentSince Jul 17, 2025 Accepting new patients
Legacy Good Samaritan Hospital and Medical Center Past Accepting new patients

Locations

1809 Maple St
Forest Grove, OR 97116
Phone (503) 357-2173

24900 SE Stark St
Ste 103
Gresham, OR 97030
Phone (503) 665-4278

335 SE 8th Ave
Hillsboro, OR 97123
Phone (503) 681-1111

10000 SE Main St
Ste 342
Portland, OR 97216
Phone (503) 232-5020

1040 NW 22nd Ave
Ste 168
Portland, OR 97210
Phone (503) 413-7022

1130 NW 22nd Ave
Ste 400
Portland, OR 97210
Phone (503) 413-6555

501 N Graham St
Ste 420
Portland, OR 97227
Phone (503) 288-7303

5050 NE Hoyt St
Ste 655
Portland, OR 97213
Phone (503) 239-6673

541 NE 20th Ave
Ste 225
Portland, OR 97232
Phone (503) 963-2801

847 NE 19th Ave
Ste 300
Portland, OR 97232

19250 SW 65th Ave
Ste 235
Tualatin, OR 97062
Phone (503) 692-1470

Organizations & group practices 12

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

Hospital & facility affiliations 9

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": "1128643200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753660800000",
    "number": "1255329967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "541 NE 20TH AVE STE 225",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972322895",
            "telephone_number": "503-963-2801",
            "fax_number": "503-963-2825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 N GRAHAM ST STE 420",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972272006",
            "telephone_number": "503-288-7303",
            "fax_number": "503-288-3806"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1130 NW 22nd Ave Ste 400",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972102971",
            "country_code": "US",
            "telephone_number": "503-413-6722",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "19250 SW 65th Ave Ste 235",
            "address_purpose": "LOCATION",
            "city": "Tualatin",
            "state": "OR",
            "postal_code": "970627745",
            "country_code": "US",
            "telephone_number": "503-692-4820",
            "fax_number": "503-612-0793",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FERNSTROM",
        "first_name": "BRUCE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-07",
        "last_updated": "2025-07-28",
        "certification_date": "2025-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA00805",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "OR",
            "license": "PA00805",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500600862",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cc_otoc_aua_urology_emanuel_front_desk_pool12223225@oc.providencedirect.org",
            "affiliation": "Y",
            "affiliationName": "The Oregon Clinic PC",
            "address_1": "501 N Graham St Ste 420",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972272006",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.