NPIMap

Individual provider Active NPI

George B Demetrion, MD

  • Internal Medicine Physician
  • Portland, OR
National Provider Identifier
1326048950
Registry record updated Oct 16, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD19902 Issued in OR
Practice address
2400 SW Vermont St
Portland, OR 97219-1940
Phone
(503) 452-0915
Fax
(503) 768-9232
NPI assigned
Jul 26, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD19902 OR Primary

Addresses

Primary practice location

2400 SW Vermont St
Portland, OR 97219-1940

Mailing address

2400 SW Vermont St
Portland, OR 97219-1940
Phone (503) 452-0915

Other identifiers 1

IdentifierTypeStateIssuer
150205MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101013001256 OR Practitioner - Internal Medicine 4385836998 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
George Washington University School of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Fanno Creek Clinic LLCGroup PAC ID 0042100521, 24 clinicians

Practice addresses (Care Compare)

2400 SW Vermont St
Portland, OR 97219-1940
Phone (503) 452-0915

Hospital & facility affiliations

  • Providence Home Health Home health agency, Portland, OR, CCN 387048
  • Providence St Vincent Medical Center Hospital, Portland, OR, CCN 380004
  • Legacy Good Samaritan Medical Center Hospital, Portland, OR, CCN 380017
  • Ohsu Hospital and Clinics Hospital, Portland, OR, CCN 380009
  • Adventist Health Tillamook Hospital, Tillamook, OR, CCN 381317
  • Providence Portland Medical Center Hospital, Portland, OR, CCN 380061

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Legacy Clinics LLC Internal Medicine CurrentSince Dec 11, 2012 Accepting new patients
Fanno Creek Clinic LLC Internal Medicine CurrentSince Jul 1, 1999 Accepting new patients

Locations

1130 NW 22nd Ave
Ste 220
Portland, OR 97210
Phone (503) 413-4134

2400 SW Vermont St
Portland, OR 97219
Phone (503) 452-0915

Organizations & group practices 2

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.

Hospital & facility affiliations 11

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

NPI Registry JSON

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

{
    "created_epoch": "1122336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1192492800000",
    "number": "1326048950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2400 SW VERMONT ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972191940",
            "telephone_number": "503-452-0915",
            "fax_number": "503-768-9232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 SW VERMONT ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972191940",
            "telephone_number": "503-452-0915",
            "fax_number": "503-768-9232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEMETRION",
        "first_name": "GEORGE",
        "middle_name": "B",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-26",
        "last_updated": "2007-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "MD19902",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "150205",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.