NPIMap

Organization Active NPI

Providence Health & Services Oregon

Doing business as Providence Milwaukie Hospital

  • General Acute Care Hospital
  • Milwaukie, OR
National Provider Identifier
1366536963
Registry record updated Apr 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
Legal business name
PROVIDENCE HEALTH & SERVICES OREGON
Doing business as
Providence Milwaukie Hospital
Practice address
10150 SE 32ND Ave
Milwaukie, OR 97222-6516
Phone
(503) 451-3000
NPI assigned
Oct 3, 2006
Last updated
Apr 29, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
PROVIDENCE HEALTH & SERVICES OREGONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 29, 2025

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

Authorized official

Name
Donald W Anderson Jr.
Title
Assistant Secretary Enrollments
Phone
(425) 358-9786

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X
Emergency Medicine Physician 207P00000X
Internal Medicine Physician 207R00000X
Nuclear Medicine Physician 207U00000X
Obstetrics & Gynecology Physician 207V00000X
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X
General Acute Care Hospital 282N00000X Primary

Addresses

Primary practice location

10150 SE 32ND Ave
Milwaukie, OR 97222-6516

Mailing address

PO Box 31001-4199
Pasadena, CA 91110-4199
Phone (503) 451-3000

Other identifiers 7

IdentifierTypeStateIssuer
C45062OtherORRAILROAD MEDICARE
050100000001OtherORPROVIDENCE HEALTH PLAN
138008200OtherORREGENCE HOSPITAL NUMBER
175620MedicaidOR
95916OtherWAWA DEPT. OF LABOR
194589600OtherORUS DEPT. OF LABOR WC
3003373OtherWAWASHINGTON MEDICAID

Other names 1

  • Providence Milwaukie Hospital Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040123000371 OR Part B Supplier - Clinic/Group Practice 6103728753 Receives reassigned benefits from 227 practitioners
1 other NPI on this enrollment
Practice locations: Milwaukie, OR
O20050712001268 OR Part A Provider - Hospital 6103728753 Practice locations: Clackamas, OR; Milwaukie, OR; Happy Valley, OR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1366536963. Details of each certification follow.

Hospital certification: CCN 380082

Legal name
PROVIDENCE HEALTH & SERVICES OREGON
Doing business as
PROVIDENCE MILWAUKIE HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1971
Last certification
Aug 27, 2014
Beds
77
Ownership / control type
Church
Organization structure
CorporationNon-profit
Incorporated
Feb 20, 1934 in OR
Enrollment address
10150 SE 32ND Ave
Milwaukie, OR 97222-6516
Main/Primary Hospital Location
Hospital subgroups
Acute care

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospital

Medicare Care Compare
Listed as
Providence Milwaukie HospitalCCN 380082 · All quality measures
Overall star rating
3 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Church
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

National Provider Directory

National Provider Directory
Part of
Providence Hood River Memorial Hospital Pharmacy

Ownership & related parties

All disclosed owners & managing parties 26

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Diane L Hejna Individual Corporate DirectorBoard Member Jul 1, 2016
Richard S Blair Individual Corporate DirectorBoard Member Jul 1, 2016
Providence Health & Services-Oregon Organization, Renton, WA Non-profit 5% Or Greater Direct Ownership Interest Dec 16, 2010
Marvin O'Quinn Individual Corporate DirectorBoard Member Jan 1, 2024
Linda Buck Individual Corporate DirectorBoard Member Jan 1, 2025
Michael King Individual W-2 Managing Employee Nov 7, 2021
Providence Health & Services - Washington Organization, Renton, WA Non-profit, Chain home office Operational/Managerial Control Dec 16, 2010
Mary E Lyons Individual Corporate DirectorBoard Member Jul 1, 2016
Phyllis M Hughes Individual Corporate Director Jan 1, 2014
Rogelio Riojas Individual Corporate DirectorBoard Member Jan 1, 2025
Brad Henry Individual W-2 Managing EmployeeChief Executive Apr 17, 2023
James Martin Individual Corporate Officer Jan 13, 2023
Charles Wallace Sorenson Individual Corporate OfficerBoard Member Dec 26, 2018
Donald Wayne Anderson Individual Corporate OfficerAssistant Secretary of Enrollments Jan 1, 2017
Gregory David Hoffman Individual Corporate OfficerCfo/Treasurer Oct 2, 2020
Isiaah D Crawford Individual Corporate Director Jan 1, 2014
Melissa Ann Damm Individual W-2 Managing EmployeeOregon Cfo Feb 18, 2019
Donna Markham Individual Corporate DirectorBoard Member Jan 1, 2024
Michael W Murphy Individual Corporate DirectorBoard Member Jan 1, 2020
Providence Health & Services Organization, Renton, WA Non-profit Other Jul 1, 2016
Mary Beth Kingston Individual Corporate Director Sep 1, 2022
Eric D Sprunk Individual Corporate Director Jan 1, 2022
Anna R Newsom Individual Corporate Officer May 13, 2022
Darryl Elmouchi Individual Corporate DirectorPresident/Ceo Apr 1, 2025
Karin Dufault Individual Corporate DirectorBoard Member Jan 1, 2025
Providence St. Joseph Health Organization, Renton, WA Corporation, Non-profit Other Jul 1, 2016

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 139

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 139

Practitioners & affiliated clinicians

Practitioners 229

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 229

Affiliated clinicians 549

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 549

NPI Registry JSON

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745884800000",
    "number": "1366536963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31001-4199",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911104199",
            "telephone_number": "503-451-3000",
            "fax_number": "503-215-0297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10150 SE 32ND AVE",
            "city": "MILWAUKIE",
            "state": "OR",
            "postal_code": "972226516",
            "telephone_number": "503-451-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH & SERVICES OREGON",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROVIDENCE HEALTH & SERVICES  OREGON",
        "enumeration_date": "2006-10-03",
        "last_updated": "2025-04-29",
        "certification_date": "2025-04-29",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY ENROLLMENTS",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207U00000X",
            "taxonomy_group": "",
            "desc": "Nuclear Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "C45062",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDENCE HEALTH PLAN",
            "identifier": "050100000001",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE HOSPITAL NUMBER",
            "identifier": "138008200",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "175620",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WA DEPT. OF LABOR",
            "identifier": "95916",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "US DEPT. OF LABOR WC",
            "identifier": "194589600",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WASHINGTON MEDICAID",
            "identifier": "3003373",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Milwaukie Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Providence Milwaukie Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Milwaukie, OR

Sources for this page

Verify at the official NPI Registry.