Nicholas An, MD
Individual provider Active NPI Anesthesiology Physician · Portland, OR
NPI 1306228853 · NPPES record last updated Jul 3, 2020
Key facts
- NPI
- 1306228853
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Anesthesiology Physician 207L00000X
- License
- MD197425 (OR)
- Practice address
- 3181 SW Sam Jackson Park Rd # 2
Portland, OR 97239-3098 - Phone
- (503) 494-7641
- Fax
- (503) 494-8368
- NPI assigned
- Jun 22, 2015
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Anesthesiology
- Education
- University of Texas Medical Branch at Galveston, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Matrix Anesthesia, PS
Practice addresses (Care Compare)
1035 116TH Ave NE
Bellevue, WA 98004-4604
Phone (425) 688-5000
Hospital & facility affiliations
- Overlake Hospital Medical Center & Clinics
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20211012002330 | WA | Practitioner - Anesthesiology | 0345573176 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A162035 | CA | MD | Anesthesiology Physician |
| MD197425 | OR | MD | Anesthesiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Matrix Anesthesia, PS | Anesthesiology | Current |
Accepting new patients |
Locations
1035 116th Ave NE
Bellevue, WA 98004
Phone (425) 451-4141
12040 NE 128th St
Ste Blue
Kirkland, WA 98034
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | A162035 | CA | |
| Anesthesiology Physician | 207L00000X | MD197425 | OR | Yes |
Addresses
Primary practice location
3181 SW Sam Jackson Park Rd # 2
Portland, OR 97239-3098
Mailing address
3181 SW Sam Jackson Park Rd
Mail Code SJH-2
Portland, OR 97239-3098
Phone (503) 494-7641
Other practice location 1
757 Westwood Plz Ste 3325
Los Angeles, CA 90095-6402
Phone (310) 267-3899
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All providers in Portland, OR · Anesthesiology Physician in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 3, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.