Evan Jacob Fertig, MD

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

MD173687 Issued in OR

Practice address

5050 NE Hoyt St
Suite 615
Portland, OR 97213-2958

Phone

(503) 215-8580

Fax

(503) 215-8585

NPI assigned

Nov 17, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Electronic endpoints 2

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Neurology

Education

Other, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Providence Health and Services OregonGroup PAC ID 0648183608, 1,423 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Providence St Vincent Medical Center Hospital, Portland, OR, CCN 380004
• Providence Portland Medical Center Hospital, Portland, OR, CCN 380061

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Providence Health & Services Oregon

  • General Practice Physician
  • Lake Oswego, OR
  • NPI 1023488343
  Medicare reassignment Care Compare group NPD
• Providence Health & Services - Oregon

  • General Acute Care Hospital
  • Portland, OR
  • NPI 1003991845
  Medicare reassignment NPD
• Providence Health & Services - Oregon

  • General Acute Care Hospital
  • Portland, OR
  • NPI 1114015971
  Medicare reassignment NPD
• Providence Health & Services - Oregon

  • General Acute Care Hospital
  • Oregon City, OR
  • NPI 1912282369
  Medicare reassignment NPD
• Providence Health & Services - Oregon

  • General Acute Care Hospital
  • Newberg, OR
  • NPI 1952482275
  Medicare reassignment NPD
• Providence Health & Services Oregon

  • Clinical Pathology Physician
  • Hood River, OR
  • NPI 1053862714
  Medicare reassignment NPD
• Providence Health & Services Oregon

  • General Acute Care Hospital
  • Milwaukie, OR
  • NPI 1366536963
  Medicare reassignment NPD
• Providence Health & Services Oregon

  • Critical Access Hospital
  • Seaside, OR
  • NPI 1578500492
  Medicare reassignment NPD
• Providence Health & Services - Oregon

  • Clinical Pathology Physician
  • Oregon City, OR
  • NPI 1003368911
  NPD
• Providence Health & Services - Oregon

  • Clinical Pathology Physician
  • Newberg, OR
  • NPI 1174074868
  NPD
• Providence Health & Services - Oregon

  • Neurology Physician
  • Portland, OR
  • NPI 1578807418
  NPD
• Providence Health & Services - Oregon

  • Clinical Pathology Physician
  • Portland, OR
  • NPI 1740732650
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Providence Health & Services - Oregon

  • General Acute Care Hospital
  • Portland, OR
  • NPI 1003991845
  Care Compare affiliation
• Providence Health & Services - Oregon

  • General Acute Care Hospital
  • Portland, OR
  • NPI 1114015971
  Care Compare affiliation
• Providence Health & Services - Oregon

  • Case Manager/Care Coordinator
  • Portland, OR
  • NPI 1891822995

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1132185600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602720000000",
    "number": "1275515918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3158",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5050 NE HOYT ST",
            "address_2": "SUITE 615",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972132958",
            "telephone_number": "503-215-8580",
            "fax_number": "503-215-8585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FERTIG",
        "first_name": "EVAN",
        "middle_name": "JACOB",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-17",
        "last_updated": "2020-10-15",
        "certification_date": "2020-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "CT",
            "license": "043292",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "OR",
            "license": "MD173687",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001432921",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0171441",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500689501",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "efertig549125@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "5050 NE HOYT ST",
            "address_2": "SUITE 615",
            "city": "PORTLAND",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972132958",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "efertig549125@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "5050 NE Hoyt St Ste 315",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972132982",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Felicia Ferruzza, LAC
• Andrew Michael Ferry, MD
• Marissa Ferry
• Megan Ferry, LMT
• Amber Ferschweiler, NBHWC
• Fertile Ground Family Center, LLC
• Aklilu Feseha
• Ayahun Feseha
• Jill L Fessenden, BSN, LMT, ABLS
• Jonathan Mark Fessler, BA, FNTP, LMT, CA

• Neurology Physician in Portland, OR
• Providers in Portland, OR by specialty
• Neurology Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2020; 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.

Verify at the official NPI Registry.