NPIMap

Individual provider Active NPI

Paul Jeffrey Aanderud, D.O.

  • Dermatology Physician
  • Clackamas, OR
National Provider Identifier
1255569273
Registry record updated May 8, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
DO157838 Issued in OR
Practice address
9775 SE Sunnyside Rd Ste 500
Clackamas, OR 97015-5724
Phone
(503) 654-7546
Fax
(503) 786-3542
NPI assigned
Jun 29, 2009
Last updated
May 8, 2013By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 8, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 5101018458 MI
Dermatology Physician 207N00000X DO157838 OR Primary

Addresses

Primary practice location

9775 SE Sunnyside Rd Ste 500
Clackamas, OR 97015-5724

Mailing address

9775 SE Sunnyside Rd Ste 500
Clackamas, OR 97015-5724
Phone (503) 654-7546

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
I20130723000547 OR Practitioner - Dermatology 1658512371 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Clackamas Dermatology PCGroup PAC ID 4183618440, 11 clinicians

Practice addresses (Care Compare)

12605 SE 97TH Ave
Clackamas, OR 97015-9706
Phone (503) 654-7546

1620 SW 257TH Ave
Troutdale, OR 97060-1490
Phone (503) 654-7546

545 SE Oak St
Hillsboro, OR 97123-4147
Phone (503) 654-7546

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
99.11 of 100Reported as apm
Quality
84.29
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision12
Removal of tissue1-10
Removal of skin lesions1294
Removal or shaving of skin growth1-10
Skin biopsy190

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5101018458MIMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Clackamas Dermatology PC Dermatology CurrentSince Apr 25, 2013 Accepting new patients
Allergy Asthma & Dermatology Associates PC Dermatology Past Accepting new patients

Locations

18345 SW Alexander St
Ste B
Beaverton, OR 97003
Phone (503) 649-9477

12605 SE 97th Ave
Clackamas, OR 97015
Phone (503) 654-7546

9775 SE Sunnyside Rd
Ste 500
Clackamas, OR 97015
Phone (503) 652-9000

545 SE Oak St
Hillsboro, OR 97123
Phone (503) 654-7546

545 SE Oak St
Ste B
Hillsboro, OR 97123
Phone (503) 648-6159

1620 SW 257th Ave
Troutdale, OR 97060
Phone (503) 654-7546

Organizations & group practices 2

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 12

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": "1246233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1367971200000",
    "number": "1255569273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9775 SE SUNNYSIDE RD STE 500",
            "city": "CLACKAMAS",
            "state": "OR",
            "postal_code": "970155724",
            "telephone_number": "503-654-7546",
            "fax_number": "503-786-3542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9775 SE SUNNYSIDE RD STE 500",
            "city": "CLACKAMAS",
            "state": "OR",
            "postal_code": "970155724",
            "telephone_number": "503-654-7546",
            "fax_number": "503-786-3542"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AANDERUD",
        "first_name": "PAUL",
        "middle_name": "JEFFREY",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-06-29",
        "last_updated": "2013-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MI",
            "license": "5101018458",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "OR",
            "license": "DO157838",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clackamas, OR

Sources for this page

Verify at the official NPI Registry.