NPIMap

Organization Active NPI

Outside in

  • Federally Qualified Health Center (FQHC)
  • Clackamas, OR
National Provider Identifier
1306594445
Registry record updated Mar 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
OUTSIDE IN
Practice address
9852 SE Empire CT
Clackamas, OR 97015-9639
Phone
(503) 535-3800
NPI assigned
Mar 17, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2022

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

Authorized official

Name
Ericka Young
Title
Revenue Cycle Manager
Phone
(503) 535-3833

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

9852 SE Empire CT
Clackamas, OR 97015-9639

Mailing address

1132 SW 13TH Ave
Portland, OR 97205-1703
Phone (503) 535-3833

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20170919002919 OR Part B Supplier - Clinic/Group Practice 9638256662 Receives reassigned benefits from 17 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Portland, OR; Clackamas, OR
O20240503003546 OR Part A Provider - Federally Qualified Health Center (FQHC) 9638256662 Practice locations: Clackamas, OR

Federally qualified health center certification: CCN 381027

Legal name
OUTSIDE IN
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 4, 2024
Last certification
Apr 4, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 14, 2021 in OR
Enrollment address
9852 SE Empire CT
Clackamas, OR 97015-9639

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 6

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

National Provider Directory

National Provider Directory
Tax ID family
Outside in10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Kiku Johnson Individual Corporate OfficerExecutive Director Nov 28, 2022
Laura Ruedinger Individual W-2 Managing Employee May 1, 2018

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Ochin, Inc.Portland, OR, CCN 931013 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Aug 1, 2020
Aug 1, 2020
Outside inPortland, OR, CCN 381005 Federally qualified health center Operational/Managerial Control (100%) Apr 1, 2022

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • Outside in
    • Federally Qualified Health Center (FQHC)
    • Portland, OR
    • NPI 1275280729

    Operational/Managerial Control

    CMS ownership
  • Outside in
    • Federally Qualified Health Center (FQHC)
    • Portland, OR
    • NPI 1972124196

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1647475200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647475200000",
    "number": "1306594445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1132 SW 13TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972051703",
            "telephone_number": "503-535-3833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9852 SE EMPIRE CT",
            "city": "CLACKAMAS",
            "state": "OR",
            "postal_code": "970159639",
            "telephone_number": "503-535-3800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OUTSIDE IN",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-17",
        "last_updated": "2022-03-17",
        "certification_date": "2022-03-17",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "ERICKA",
        "authorized_official_title_or_position": "REVENUE CYCLE MANAGER",
        "authorized_official_telephone_number": "503-535-3833"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clackamas, OR

Sources for this page

Verify at the official NPI Registry.