Active NPI
Diana Elizabeth Gwinn, DD1
- Adult Care Home Facility
- Portland, OR
National Provider Identifier
1386122687
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Care Home Facility
- License
- 10465
- Practice address
- 16405 NE Fargo Cir
Portland, OR 97230-5513 - Phone
- (503) 484-7287
- Fax
- (503) 210-5974
- NPI assigned
- Jul 30, 2018
- Last updated
- Jul 30, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Care Home Facility | 311ZA0620X | 10465 | OR | Primary |
Addresses
Primary practice location
16405 NE Fargo Cir
Portland, OR 97230-5513
Mailing address
16405 NE Fargo Cir
Portland, OR 97230-5513
Phone (503) 484-7287
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 500745787 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10465 | OR | MD | Adult Care Home Facility |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1532908800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1532908800000",
"number": "1386122687",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16405 NE FARGO CIR",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972305513",
"telephone_number": "503-484-7287",
"fax_number": "503-210-5974"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16405 NE FARGO CIR",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972305513",
"telephone_number": "503-484-7287",
"fax_number": "503-210-5974"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GWINN",
"first_name": "DIANA",
"middle_name": "ELIZABETH",
"credential": "DD1",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-07-30",
"last_updated": "2018-07-30",
"status": "A"
},
"taxonomies": [
{
"code": "311ZA0620X",
"taxonomy_group": "",
"desc": "Custodial Care Facility, Adult Care Home",
"state": "OR",
"license": "10465",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "500745787",
"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 Jul 30, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.