Active NPI
Ryan Gregory Reseburg, PMHNP
- Psychiatric/Mental Health Nurse Practitioner
- Portland, OR
National Provider Identifier
1275368474
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner
- License
- 10032073
- Practice address
- 10300 SW Eastridge St
Portland, OR 97225-5004 - Phone
- (503) 944-5000
- NPI assigned
- Sep 6, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 10032073 | OR | Primary |
Addresses
Primary practice location
10300 SW Eastridge St
Portland, OR 97225-5004
Mailing address
2005 N Williams Ave Apt 539
Portland, OR 97227-2057
Phone (503) 400-4447
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: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2024
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
10300 SW Eastridge St
Portland, OR 97225-5004
Phone (503) 944-5000
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ubh of Oregon, LLC | Single Specialty | Current | Accepting new patients |
Locations
10300 SW Eastridge St
Portland, OR 97225
Phone (503) 944-5000
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1725580800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1725580800000",
"number": "1275368474",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2005 N WILLIAMS AVE APT 539",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972272057",
"telephone_number": "503-400-4447"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10300 SW EASTRIDGE ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972255004",
"telephone_number": "503-944-5000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RESEBURG",
"first_name": "RYAN",
"middle_name": "GREGORY",
"credential": "PMHNP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-09-06",
"last_updated": "2024-09-06",
"certification_date": "2024-09-06",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0808X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Nurse Practitioner, Psychiatric/Mental Health",
"state": "OR",
"license": "10032073",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.