Providence Portland Medical Center

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

Legal business name

PROVIDENCE PORTLAND MEDICAL CENTER

Doing business as

Prov Nurse Practitioners East

Practice address

4805 NE Glisan St
Portland, OR 97213-2933

Phone

(503) 215-6185

NPI assigned

Oct 15, 2008

Organization subpart

No

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

Authorized official

Name

Donald W Anderson Jr.

Title

Assistant Secretary Enrollments

Phone

(425) 358-9786

Specialties & licenses 1

Addresses

Other names 1

• PROV NURSE PRACTITIONERS EAST Doing business as

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Other NPIs on the same Medicare enrollment 2

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

• Providence Health & Services - Oregon

  dba Providence Portland Medical Center

  • General Acute Care Hospital
  • Portland, OR
  • NPI 1003991845

  O20031113000626

  Same enrollment
• Providence Health & Services - Oregon

  dba Providence Portland Medical Center

  • Clinical Pathology Physician
  • Portland, OR
  • NPI 1740732650

  O20031113000626

  Same enrollment

Practitioners 1

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

• Maureen Ann Jones, FNP

  • Family Nurse Practitioner
  • Bayboro, NC
  • NPI 1700861424
  NPD (past)

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

{
    "created_epoch": "1224028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1746576000000",
    "number": "1316199987",
    "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": "4805 NE GLISAN ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972132933",
            "telephone_number": "503-215-6185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE PORTLAND MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-15",
        "last_updated": "2025-05-07",
        "certification_date": "2025-05-07",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY ENROLLMENTS",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PROV NURSE PRACTITIONERS EAST",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Providence Health System Oregon (Providence Elder Place Portland)
• Providence Porland Medical Center
• Providence Portland Cancer Center
• Providence Portland Medical Center (Providence Hospitalists East)
• Providence Portland Medical Center (Providence Integrative Medicine East)
• Providence Portland Medical Center
• Providence Portland Medical Center (Providence Arthritis Center)
• Providence St Vincent
• Providence St Vincent Hospital
• Providence St Vincent Medical Center (Providence Integrative Medicine West)

• Nurse Practitioner in Portland, OR
• Providers in Portland, OR by specialty
• Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2025; 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.