NPIMap

Individual provider Active NPI

Proleta Datta, MD PHD

  • Neurology Physician
  • Portland, OR
National Provider Identifier
1326393695
Registry record updated Jun 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
30734 Issued in NE
Practice address
3181 SW Sam Jackson Park Rd
Portland, OR 97239-3011
Phone
(503) 494-7772
Fax
(503) 494-7242
NPI assigned
Jul 23, 2012
Last updated
Jun 3, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2021

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X BP10043519 TX
Neurology Physician 2084N0400X 30734 NE Primary
Neurology Physician 2084N0400X MD203710 OR
Neurology Physician 2084N0400X A142041 CA

Addresses

Primary practice location

3181 SW Sam Jackson Park Rd
Portland, OR 97239-3011

Mailing address

3181 SW Sam Jackson Park Rd
Portland, OR 97239-3011
Phone (503) 494-7772

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE, OR2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20180716000503 NE Practitioner - Neurology 7719279090 Reassigns benefits to 1 organization
I20210506001851 OR Practitioner - Neurology 7719279090 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Bay Area Hospital DistrictGroup PAC ID 2163331000, 117 clinicians
University Professional ServicesGroup PAC ID 4880760107, 1,683 clinicians
Tuality Medical Group LLCGroup PAC ID 7416173414, 289 clinicians

Practice addresses (Care Compare)

1775 Thompson Rd
Coos Bay, OR 97420-2125
Phone (541) 269-8280

2650 N 17TH St
Coos Bay, OR 97420-2134
Phone (541) 269-8282

3181 SW Sam Jackson Park Rd
Portland, OR 97239-3011
Phone (503) 494-8311

335 SE 8TH Ave
Hillsboro, OR 97123-4246
Phone (503) 681-1111

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A142041CAMDNeurology Physician
30734NEMDNeurology Physician
BP10043519TXMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
University Professional Services CurrentSince Jun 1, 2021 Accepting new patients
Tuality Medical Group LLC CurrentSince Dec 1, 2022 Accepting new patients
Columbia Lutheran Charities Current Accepting new patients
Bay Area Hospital District CurrentSince Dec 14, 2021 Accepting new patients
Bay Area Hospital District CurrentSince Dec 14, 2021 Accepting new patients
University Professional Services Current Accepting new patients
Unmc Physicians CurrentSince Jul 1, 2018 Accepting new patients
Tuality Medical Group LLC Neurology CurrentSince Dec 1, 2022 Accepting new patients
University Professional Services CurrentSince Jun 1, 2021 Accepting new patients
Columbia Lutheran Charities CurrentSince Oct 9, 2022 Accepting new patients
Columbia Lutheran Charities Past Accepting new patients
University Professional Services Past Accepting new patients
Oregon Health & Science University Past Accepting new patients
Faith Regional Health Services Past Accepting new patients
Columbia Lutheran Charities Past Accepting new patients

Locations

Dept LA 25339
Pasadena, CA 91185

4242 Farnam St
Ste 650
Omaha, NE 68131
Phone (402) 502-8787

988102 Nebraska Medical Ctr
Omaha, NE 68198
Phone (402) 559-1010

Emile 42nd St
Omaha, NE 68198
Phone (402) 552-6731

2111 Exchange St
Astoria, OR 97103
Phone (503) 325-4321

15700 SW Greystone Ct
Beaverton, OR 97006
Phone (503) 203-1000

2650 N 17th St
Coos Bay, OR 97420
Phone (541) 267-5411

335 SE 8th Ave
Hillsboro, OR 97123
Phone (503) 681-1111

3181 SW Sam Jackson Park Rd
Portland, OR 97239
Phone (503) 494-5674

Interoperability endpoints

  • Direct secure messaging: pdatta133612@direct.ohsu.edu

Organizations & group practices 15

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

View all 15

Hospital & facility affiliations 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1343001600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622678400000",
    "number": "1326393695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3181 SW SAM JACKSON PARK RD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972393011",
            "telephone_number": "503-494-7772",
            "fax_number": "503-494-7242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3181 SW SAM JACKSON PARK RD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972393011",
            "telephone_number": "503-494-7772",
            "fax_number": "503-494-7242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DATTA",
        "first_name": "PROLETA",
        "name_prefix": "Dr.",
        "credential": "MD PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-23",
        "last_updated": "2021-06-03",
        "certification_date": "2021-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "TX",
            "license": "BP10043519",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "NE",
            "license": "30734",
            "primary": true
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "OR",
            "license": "MD203710",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "CA",
            "license": "A142041",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.