Individual provider Active NPI

Colby E Harrison, M.D.

  • Internal Medicine Physician
  • Portland, OR
National Provider Identifier
1366604589
Registry record updated Feb 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD126182 Issued in OR
Practice address
4805 NE Glisan St
Portland, OR 97213-2933
Phone
(503) 215-2392
NPI assigned
Jun 29, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2021

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 4835321-1205 UT
Internal Medicine Physician 207R00000X MD60840742 WA
Hospitalist Physician 208M00000X MD126182 OR
Internal Medicine Physician 207R00000X MD126182 OR Primary

Addresses

Primary practice location

4805 NE Glisan St
Portland, OR 97213-2933

Mailing address

PO Box 3158
Portland, OR 97208-3158
Phone (503) 215-6494

Other practice location 1

4805 NE Glisan St
Ste BG05
Portland, OR 97213-2933
Phone (503) 215-2392

Other practice location 2

700 NE 87th Ave
Vancouver, WA 98664
Phone (360) 882-2778

Other identifiers 1

IdentifierTypeStateIssuer
500609567MedicaidOR

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address charrison118155@oc.providencedirect.org

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090821000530 OR Practitioner - Internal MedicinePractitioner - Hospitalist 9436203684 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Hospitalist
Education
Oregon Health Sciences University School of Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

4805 NE Glisan St
Portland, OR 97213-2933

5050 NE Hoyt St
Suite 240
Portland, OR 97213-2981
Phone (503) 215-6480

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4835321-1205UTMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services - Oregon Internal Medicine CurrentSince Aug 1, 2020 Accepting new patients
Providence Health & Services Oregon Current Accepting new patients
Providence Health & Services Oregon CurrentSince Aug 1, 2020 Accepting new patients
Providence Health & Services - Oregon Internal Medicine CurrentSince Aug 1, 2020 Accepting new patients

Locations

4805 NE Glisan St
Ste BG5
Portland, OR 97213
Phone (503) 215-2392

4805 NE Glisan St
Portland, OR 97213
Phone (503) 215-1111

Interoperability endpoints

  • Direct secure messaging: charrison12871@tvc-direct.org

Organizations & group practices 4

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1214697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613088000000",
    "number": "1366604589",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4805 NE GLISAN ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972132933",
            "telephone_number": "503-215-2392"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4805 NE Glisan St",
            "address_2": "STE BG05",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972132933",
            "country_code": "US",
            "telephone_number": "503-215-2392",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "700 NE 87th Ave",
            "address_purpose": "LOCATION",
            "city": "Vancouver",
            "state": "WA",
            "postal_code": "98664",
            "country_code": "US",
            "telephone_number": "360-882-2778",
            "fax_number": "360-604-1767",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HARRISON",
        "first_name": "COLBY",
        "middle_name": "E",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-29",
        "last_updated": "2021-02-12",
        "certification_date": "2021-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "UT",
            "license": "4835321-1205",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "MD60840742",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "OR",
            "license": "MD126182",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "MD126182",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500609567",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "charrison118155@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "4805 NE Glisan St",
            "address_2": "STE BG05",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972132933",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.