NPIMap

Organization Active NPI

Providence Health & Services - Oregon

Doing business as Providence Occupational Medicine-Tanasbourne/Bridgeport

  • Occupational Medicine Clinic/Center
  • Hillsboro, OR
National Provider Identifier
1306174438
Registry record updated Mar 30, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational Medicine Clinic/CenterTaxonomy code 261QX0100X
Legal business name
PROVIDENCE HEALTH & SERVICES - OREGON
Doing business as
Providence Occupational Medicine-Tanasbourne/Bridgeport
Practice address
18610 NW Cornell Rd
Suite 204
Hillsboro, OR 97124-9204
Phone
(503) 216-7960
Fax
(503) 216-0211
NPI assigned
Dec 1, 2009
Last updated
Mar 30, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2017

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

Authorized official

Name
Donald W Anderson Jr.
Title
Reimbursement Director-Administrati
Phone
(425) 525-5392

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Medicine Clinic/Center 261QX0100X Primary

Addresses

Primary practice location

18610 NW Cornell Rd
Suite 204
Hillsboro, OR 97124-9204

Mailing address

PO Box 4388
Portland, OR 97208-4388
Phone (503) 216-7960

Other names 1

  • Providence Occupational Medicine-Tanasbourne/Bridgeport Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040126000526 OR Part B Supplier - Clinic/Group Practice 6305755000 Receives reassigned benefits from 20 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Portland, OR; Medford, OR; Beaverton, OR

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1259625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1490832000000",
    "number": "1306174438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4388",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972084388",
            "telephone_number": "503-216-7960",
            "fax_number": "503-215-6387"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18610 NW CORNELL RD",
            "address_2": "SUITE 204",
            "city": "HILLSBORO",
            "state": "OR",
            "postal_code": "971249204",
            "telephone_number": "503-216-7960",
            "fax_number": "503-216-0211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH & SERVICES - OREGON",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-01",
        "last_updated": "2017-03-30",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "REIMBURSEMENT DIRECTOR-ADMINISTRATI",
        "authorized_official_telephone_number": "425-525-5392",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "261QX0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Occupational Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Occupational Medicine-Tanasbourne/Bridgeport",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hillsboro, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.