Active NPI
Todd Shane Crocenzi, M.D.
- Medical Oncology Physician
- Portland, OR
National Provider Identifier
1336130806
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Oncology Physician
- License
- MD26231
- Practice address
- 4805 NE Glisan St
6N40
Portland, OR 97213-2933 - Phone
- (503) 215-5696
- Fax
- (503) 215-5695
- NPI assigned
- Nov 2, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Oncology Physician | 207RX0202X | MD26231 | OR | Primary |
Addresses
Primary practice location
4805 NE Glisan St
6N40
Portland, OR 97213-2933
Mailing address
PO Box 3158
Portland, OR 97208-3158
Phone (503) 215-6494
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 027918 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD26231 | OR | MD | Medical Oncology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Providence Health & Services - Oregon | Past | Accepting new patients | |
| The Oregon Clinic PC | Medical Oncology | Past | Accepting new patients |
| The Oregon Clinic, PC | Past | Accepting new patients |
Interoperability endpoints
- tcrocenzi118133@oc.providencedirect.org
Organizations & group practices 3
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.
-
- Family Medicine Physician
- Gresham, OR
- NPI 1053419218
-
- Durable Medical Equipment & Medical Supplies
- Portland, OR
- NPI 1346105129
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1130889600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1225238400000",
"number": "1336130806",
"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",
"telephone_number": "503-215-6494",
"fax_number": "503-215-6644"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4805 NE GLISAN ST",
"address_2": "6N40",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972132933",
"telephone_number": "503-215-5696",
"fax_number": "503-215-5695"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CROCENZI",
"first_name": "TODD",
"middle_name": "SHANE",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-02",
"last_updated": "2008-10-29",
"status": "A"
},
"taxonomies": [
{
"code": "207RX0202X",
"taxonomy_group": "",
"desc": "Internal Medicine, Medical Oncology",
"state": "OR",
"license": "MD26231",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "027918",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.