NPIMap

Individual provider Active NPI

Roberta W Ruggeri, D.O.

  • Family Medicine Physician
  • Milwaukie, OR
National Provider Identifier
1396735254
Registry record updated Aug 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
DO21865 Issued in OR
Practice address
2250 SE Oakgrove Blvd
Suite B
Milwaukie, OR 97267-2659
Phone
(503) 654-6567
Fax
(503) 653-2582
NPI assigned
Oct 24, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X DO21865 OR Primary

Addresses

Primary practice location

2250 SE Oakgrove Blvd
Suite B
Milwaukie, OR 97267-2659

Mailing address

2250 SE Oakgrove Blvd
Suiteb
Milwaukie, OR 97267-2659
Phone (503) 654-6567

Other identifiers 6

IdentifierTypeStateIssuer
275744501OtherORCIGNA
A006OtherORTRICARE
7471260OtherORAETNA INS
080175728OtherORRAILROAD MEDICARE
287646MedicaidOR
067039108OtherORREGENCE BLUE CROSS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110105000706 OR Practitioner - Family Practice 7911071899 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
College of Osteo Med of the Pacific at Pomona, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

2250 SE Oak Grove Blvd
Suite B
Milwaukie, OR 97267-2670
Phone (503) 654-6567

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
DO21865ORMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Oak Grove Family Medical Clinic P C Family Medicine CurrentSince Jul 1, 2001 Accepting new patients

Locations

2250 SE Oak Grove Blvd
Oak Grove, OR 97267
Phone (503) 654-6567

2250 SE Oak Grove Blvd
Ste B
Portland, OR 97267
Phone (503) 653-1860

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/DDABCA/Endpoint/DDABCA

Organizations & group practices 1

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 8

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": "1130112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661212800000",
    "number": "1396735254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2250 SE OAKGROVE BLVD",
            "address_2": "SUITEB",
            "city": "MILWAUKIE",
            "state": "OR",
            "postal_code": "972672659",
            "telephone_number": "503-654-6567",
            "fax_number": "503-653-2582"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2250 SE OAKGROVE BLVD",
            "address_2": "SUITE B",
            "city": "MILWAUKIE",
            "state": "OR",
            "postal_code": "972672659",
            "telephone_number": "503-654-6567",
            "fax_number": "503-653-2582"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUGGERI",
        "first_name": "ROBERTA",
        "middle_name": "W",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-24",
        "last_updated": "2022-08-23",
        "certification_date": "2022-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "DO21865",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "275744501",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "A006",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA INS",
            "identifier": "7471260",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "080175728",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "287646",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE CROSS",
            "identifier": "067039108",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukie, OR

Sources for this page

Verify at the official NPI Registry.