Individual provider Active NPI

Sean Patrick Tushla, MD

  • Hospitalist Physician
  • Portland, OR
National Provider Identifier
1376576983
Registry record updated Oct 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
MD24128 Issued in OR
Practice address
4805 NE Glisan St
Ste BG05
Portland, OR 97213-2933
Phone
(503) 215-2393
Fax
(503) 215-6918
NPI assigned
Jul 8, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD24128 OR
Hospitalist Physician 208M00000X MD24128 OR Primary

Addresses

Primary practice location

4805 NE Glisan St
Ste BG05
Portland, OR 97213-2933

Mailing address

PO Box 3158
Portland, OR 97208-3158

Other identifiers 3

IdentifierTypeStateIssuer
P00465307OtherORRR MEDICARE (PH&S)-PMG
234445MedicaidOR
1376576983MedicaidWA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address stushla104174@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
I20041015000878 OR Practitioner - HospitalistPractitioner - Internal Medicine 6608836333 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
HospitalistAlso: Internal Medicine
Education
Creighton University School of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Providence Health and Services OregonGroup PAC ID 0648183608, 1,423 clinicians

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

  • Providence Portland Medical Center Hospital, Portland, OR, CCN 380061

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services Oregon CurrentSince Apr 7, 2006 Accepting new patients
Providence Health & Services Oregon Current Accepting new patients
Cogent Healthcare of Washington, PC Internal Medicine Past Accepting new patients
Providence Health & Services - Oregon Internal Medicine Past Accepting new patients

Locations

1003 N Providence Dr
Ste 325
Newberg, OR 97132
Phone (503) 216-1661

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

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

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

Interoperability endpoints

  • Direct secure messaging: stushla104174@oc.providencedirect.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": "1152316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603152000000",
    "number": "1376576983",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4805 NE GLISAN ST",
            "address_2": "STE BG05",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972132933",
            "telephone_number": "503-215-2393",
            "fax_number": "503-215-6918"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TUSHLA",
        "first_name": "SEAN",
        "middle_name": "PATRICK",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-08",
        "last_updated": "2020-10-20",
        "certification_date": "2020-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "MD24128",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "OR",
            "license": "MD24128",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE (PH&S)-PMG",
            "identifier": "P00465307",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "234445",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1376576983",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "stushla104174@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.