NPIMap

Organization Active NPI

Providence Health & Services Oregon

Doing business as Providence Portland Medical Center

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Portland, OR
National Provider Identifier
1396818993
Registry record updated May 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
PROVIDENCE HEALTH & SERVICES OREGON
Doing business as
Providence Portland Medical Center
Practice address
4805 NE Glisan St
Portland, OR 97213-2933
Phone
(503) 215-4323
Fax
(503) 215-0297
NPI assigned
Nov 15, 2006
Last updated
May 7, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
PROVIDENCE HEALTH & SERVICES - OREGONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 7, 2025

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

Authorized official

Name
Donald W Anderson Jr.
Title
Assistant Secretary Enrollments
Phone
(425) 358-9786

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X NU Primary

Addresses

Primary practice location

4805 NE Glisan St
Portland, OR 97213-2933

Mailing address

PO Box 3395
Portland, OR 97208-3395
Phone (503) 215-4323

Other names 1

  • Providence Portland Medical Center Doing business as

National Provider Directory

National Provider Directory
Part of
Providence Hood River Memorial Hospital Pharmacy

Locations

270 NW Burnside Rd
Gresham, OR 97030
Phone (503) 215-9141

1111 NE 99th Ave
Ste 100
Portland, OR 97220
Phone (503) 215-6660

1111 NE 99th Ave
Ste 201
Portland, OR 97220
Phone (503) 962-1020

1235 NE 47th Ave
Ste 148
Portland, OR 97213
Phone (503) 215-4601

1305 SW 1st Ave
Portland, OR 97201
Phone (503) 228-5676

2705 E Burnside St
Ste 114
Portland, OR 97214
Phone (503) 215-6262

4400 NE Halsey St
Ste 200A
Portland, OR 97213
Phone (503) 215-6660

4805 NE Glisan St
#16
Portland, OR 97213
Phone (503) 215-2391

4805 NE Glisan St
#2E15
Portland, OR 97213
Phone (503) 215-1730

4805 NE Glisan St
Ste 6N20
Portland, OR 97213
Phone (503) 215-1100

5050 NE Hoyt St
Ste 118
Portland, OR 97213
Phone (503) 215-1872

5050 NE Hoyt St
Ste 520
Portland, OR 97213
Phone (503) 215-6600

5050 NE Hoyt St
Ste B45
Portland, OR 97213
Phone (503) 215-2284

9135 SW Barnes Rd
Ste 263
Portland, OR 97225
Phone (503) 216-0860

3101 SE 192nd Ave
Ste 104
Vancouver, WA 98683
Phone (360) 553-7480

3101 SE 192nd Ave
Ste 106
Vancouver, WA 98683
Phone (360) 553-7400

Practitioners & affiliated clinicians

Practitioners 724

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 724

NPI Registry JSON

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

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1746576000000",
    "number": "1396818993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3395",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083395",
            "telephone_number": "503-215-4323",
            "fax_number": "503-215-0297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4805 NE GLISAN ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972132933",
            "telephone_number": "503-215-4323",
            "fax_number": "503-215-0297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH & SERVICES OREGON",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROVIDENCE HEALTH & SERVICES - OREGON",
        "enumeration_date": "2006-11-15",
        "last_updated": "2025-05-07",
        "certification_date": "2025-05-07",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY ENROLLMENTS",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Portland Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Providence Portland Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 May 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.