Active NPI
NGC Endoscopy Services LLC
- Ambulatory Surgical Clinic/Center
- Portland, OR
National Provider Identifier
1366529638
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ambulatory Surgical Clinic/Center
- License
- 07 1539
- 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
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) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100355 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
Enrollment records 1
Care Compare: Ambulatory surgical center
Medicare Care Compare- Listed as
- Northwest Gastroenterology Clinic LLC
- Medicare certification status
- Active
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 38D1062487 | NGC Endoscopy Services LLC | Certificate of waiver | Dec 14, 2026 |
National Provider Directory
National Provider DirectoryLocations
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.
-
- Gastroenterology Physician
- Portland, OR
- NPI 1356640544
-
- Gastroenterology Physician
- Portland, OR
- NPI 1801018122
-
- Specialist
- Portland, OR
- NPI 1164534608
-
- Specialist
- Portland, OR
- NPI 1205948726
-
- Family Nurse Practitioner
- Bend, OR
- NPI 1477717130
-
- Specialist
- Portland, OR
- NPI 1417052762
-
- Hospitalist Physician
- Portland, OR
- NPI 1811317944
-
- Gastroenterology Physician
- Portland, OR
- NPI 1942417118
-
- Gastroenterology Physician
- Clackamas, OR
- NPI 1730380791
-
- Specialist
- Portland, OR
- NPI 1215049721
-
- Gastroenterology Physician
- Portland, OR
- NPI 1962590570
-
- Family Nurse Practitioner
- Portland, OR
- NPI 1902139462
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.