NPIMap

Organization Active NPI

Legacy Mount Hood Medical Center

Doing business as Legacy Mount Hood Providers

  • Clinic/Center
  • Gresham, OR
National Provider Identifier
1386919132
Registry record updated Apr 2, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
LEGACY MOUNT HOOD MEDICAL CENTER
Doing business as
Legacy Mount Hood Providers
Practice address
24800 SE Stark St
Gresham, OR 97030-3378
Phone
(503) 413-5089
Fax
(503) 413-1860
NPI assigned
Mar 13, 2012
Last updated
Apr 2, 2015By the provider in NPPES
Organization subpart
Yes
Parent organization
LEGACY MOUNT HOOD MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 2, 2015

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

Authorized official

Name
Linda Hoff
Title
Senior VP and Cfo
Phone
(503) 415-5730

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

24800 SE Stark St
Gresham, OR 97030-3378

Mailing address

PO Box 4365
Portland, OR 97208-4365
Phone (503) 413-3958

Other names 1

  • Legacy Mount Hood Providers Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040401000550 OR Part B Supplier - Clinic/Group Practice 3173515996 Receives reassigned benefits from 141 practitioners
1 other NPI on this enrollment
Practice locations: Gresham, OR; Portland, OR

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.

National Provider Directory

National Provider Directory
Part of
Legacy Mount Hood Medical Center

Locations

25050 SE Stark St
Ste 250
Gresham, OR 97030
Phone (503) 413-2005

Practitioners & affiliated clinicians

Practitioners 153

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 153

NPI Registry JSON

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

{
    "created_epoch": "1331596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1427932800000",
    "number": "1386919132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4365",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972084365",
            "telephone_number": "503-413-3958",
            "fax_number": "503-413-3212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24800 SE STARK ST",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970303378",
            "telephone_number": "503-413-5089",
            "fax_number": "503-413-1860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY MOUNT HOOD MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LEGACY MOUNT HOOD MEDICAL CENTER",
        "enumeration_date": "2012-03-13",
        "last_updated": "2015-04-02",
        "status": "A",
        "authorized_official_last_name": "HOFF",
        "authorized_official_first_name": "LINDA",
        "authorized_official_title_or_position": "SENIOR VP AND CFO",
        "authorized_official_telephone_number": "503-415-5730"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Legacy Mount Hood Providers",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gresham, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2015; 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.