Organization Active NPI

NGC Endoscopy Services LLC

  • Ambulatory Surgical Clinic/Center
  • Portland, OR
National Provider Identifier
1366529638
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
07 1539 Issued in OR
Legal business name
NGC ENDOSCOPY SERVICES LLC
Practice address
1130 NW 22ND Ave Ste 410
Portland, OR 97210-2911
Phone
(503) 229-7137
NPI assigned
Nov 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Roland William Bennetts
Title
Medical Director
Phone
(503) 229-7137

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 07 1539 OR Primary

Addresses

Primary practice location

1130 NW 22ND Ave Ste 410
Portland, OR 97210-2911

Mailing address

1130 NW 22ND Ave Ste 615
Portland, OR 97210-2977
Phone (503) 229-7137

Other identifiers 1

IdentifierTypeStateIssuer
100355MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060315000465 OR Part B Supplier - Ambulatory Surgical Center 6507873536 Receives reassigned benefits from 1 practitioner
Practice locations: Portland, OR

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Northwest Gastroenterology Clinic LLCCCN 38C0001046
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
38D1062487NGC Endoscopy Services LLC1130 NW 22ND Ave Suite 615, Portland, OR 97210Certificate of waiverDec 14, 2026

National Provider Directory

National Provider Directory

Locations

1130 NW 22nd Ave
Ste 615
Portland, OR 97210
Phone (503) 229-7137

Practitioners & affiliated clinicians

Practitioners 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1366529638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1130 NW 22ND AVE STE 615",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972102977",
            "telephone_number": "503-229-7137",
            "fax_number": "503-241-0628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1130 NW 22ND AVE STE 410",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972102911",
            "telephone_number": "503-229-7137"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NGC ENDOSCOPY SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BENNETTS",
        "authorized_official_first_name": "ROLAND",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "503-229-7137",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "OR",
            "license": "07 1539",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100355",
            "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 Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.