Cedar Creek Internal Medicine,PC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

CEDAR CREEK INTERNAL MEDICINE,PC

Practice address

10200 SW Eastridge St
Ste 205
Portland, OR 97225-5064

Phone

(503) 280-4555

Fax

(503) 280-4559

NPI assigned

Oct 26, 2006

Last updated

Nov 13, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Bradley J Fancher, MDNPI 1184733859

Title

President

Phone

(503) 280-4555

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 8

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.

• Duc Hoai Nguyen, DO

  • Internal Medicine Physician
  • Portland, OR
  • NPI 1275565814
  Medicare reassignment NPD
• Bradley J Fancher, MD

  • Internal Medicine Physician
  • Portland, OR
  • NPI 1184733859
  NPD Authorized official
• Steven C Beeson, MD

  • Internal Medicine Physician
  • Portland, OR
  • NPI 1538278296
  NPD (past)
• Coleen A Connolly, MD

  • Internal Medicine Physician
  • Portland, OR
  • NPI 1588773253
  NPD (past)
• Janette L Green, M.D.

  • Internal Medicine Physician
  • Portland, OR
  • NPI 1225029986
  NPD (past)
• Theodore J Kleikamp, MD

  • Internal Medicine Physician
  • Portland, OR
  • NPI 1427167105
  NPD (past)
• Madhavi Murthy, MD

  • Internal Medicine Physician
  • Portland, OR
  • NPI 1144323619
  NPD (past)
• Fawn Tran, MD

  • Family Medicine Physician
  • Portland, OR
  • NPI 1346353646
  NPD (past)

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

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1352764800000",
    "number": "1265517437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10200 SW EASTRIDGE ST",
            "address_2": "STE 205",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972255064",
            "telephone_number": "503-280-4555",
            "fax_number": "503-280-4559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10200 SW EASTRIDGE ST",
            "address_2": "STE 205",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972255064",
            "telephone_number": "503-280-4555",
            "fax_number": "503-280-4559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CEDAR CREEK INTERNAL MEDICINE,PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-26",
        "last_updated": "2012-11-13",
        "status": "A",
        "authorized_official_last_name": "FANCHER",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "503-280-4555",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julie Bergenser Cech, CRNA
• Valerie Lynn Cecil, FNP
• Cynthia Ceciliani
• Kristi Ceciliani
• Denny Cecilio Guzman
• Cedar Hills Ambulatory Surgery Center LLC (Cedar Hills Surgery Center)
• Cedar Hills Dental Care
• Cedar Hills Dentistry for Kids LLC
• Cedar Hills Legacy Dental LLC
• Cedar Hills Vision Clinic Inc

• Internal Medicine Physician in Portland, OR
• Providers in Portland, OR by specialty
• Internal Medicine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.