Northwest Minimally Invasive Surgery, LLC

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

Legal business name

NORTHWEST MINIMALLY INVASIVE SURGERY, LLC

Practice address

1040 NW 22ND Ave Ste 470
Portland, OR 97210-3062

Phone

(503) 914-0024

Fax

(503) 914-0025

NPI assigned

Aug 2, 2017

Organization subpart

No

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

Authorized official

Name

Dr. Daniel Tseng, MDNPI 1366477374

Title

President

Phone

(503) 914-0024

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OR, WA2 enrollments

Enrollment records 2

Locations

Practitioners 6

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.

• Daniel Tseng, M.D.

  • Surgery Physician
  • Portland, OR
  • NPI 1366477374

  WA

  Medicare reassignment Care Compare group NPD Authorized official
• Paul Michael Kaminsky, MD/PHD

  • Colon & Rectal Surgery Physician
  • Portland, OR
  • NPI 1295173763

  Multi-Specialty, WA

  Medicare reassignment Care Compare group NPD
• Jeffrey Robert Watkins, M.D.

  • Surgery Physician
  • Vancouver, WA
  • NPI 1720373509

  OR

  Medicare reassignment Care Compare group NPD
• Sabrina Drexel, MD

  • Surgery Physician
  • Portland, OR
  • NPI 1477971117

  WA

  Medicare reassignment NPD
• Carey Wickham

  • Colon & Rectal Surgery Physician
  • Portland, OR
  • NPI 1750820007

  Multi-Specialty, WA

  Medicare reassignment NPD
• Karen Sue Ulloth, M.D.

  • Surgery Physician
  • Portland, OR
  • NPI 1235181439
  NPD (past)

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

{
    "created_epoch": "1501632000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1386168029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1040 NW 22ND AVE STE 470",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972103062",
            "telephone_number": "503-914-0024",
            "fax_number": "503-914-0025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1040 NW 22ND AVE STE 470",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972103062",
            "telephone_number": "503-914-0024",
            "fax_number": "503-914-0025"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2222 NW Lovejoy St Ste 322",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972105101",
            "country_code": "US",
            "telephone_number": "503-731-3700",
            "fax_number": "971-634-2087",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NORTHWEST MINIMALLY INVASIVE SURGERY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-02",
        "last_updated": "2022-07-21",
        "certification_date": "2022-06-23",
        "status": "A",
        "authorized_official_last_name": "TSENG",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "503-914-0024",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208C00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Colon & Rectal Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Surgery Physician in Portland, OR
• Providers in Portland, OR by specialty
• Surgery Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.