NPIMap

Organization Active NPI

Rose City Medical LLC

  • Clinic/Center
  • Portland, OR
National Provider Identifier
1417217894
Registry record updated Feb 26, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
85696897 Issued in OR
Legal business name
ROSE CITY MEDICAL LLC
Practice address
135 NE 102ND Ave
Portland, OR 97220-4167
Phone
(503) 894-9005
Fax
(503) 719-4178
NPI assigned
May 20, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2016

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

Authorized official

Name
Maria Lynn Sullivan
Title
Business Director
Phone
(503) 894-9005

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 85696897 OR Primary
Urgent Care Clinic/Center 261QU0200X 85696897 OR

Addresses

Primary practice location

135 NE 102ND Ave
Portland, OR 97220-4167

Mailing address

135 NE 102ND Ave
Portland, OR 97220-4167
Phone (503) 894-9005

Other identifiers 2

IdentifierTypeStateIssuer
500646730MedicaidOR
R167408OtherORMEDICARE PTAN

Other names 1

  • Rose City Urgent Care and Family Practice Doing business as

National Provider Directory

National Provider Directory

Locations

2075 NE Division St
Gresham, OR 97030
Phone (503) 512-1040

6110B N Lombard St
Portland, OR 97203
Phone (503) 894-9005

11155 NE Halsey St
Portland, OR 97220
Phone (503) 894-9005

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1337472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1456444800000",
    "number": "1417217894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "135 NE 102ND AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972204167",
            "telephone_number": "503-894-9005",
            "fax_number": "503-719-4178"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "135 NE 102ND AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972204167",
            "telephone_number": "503-894-9005",
            "fax_number": "503-719-4178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROSE CITY MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-20",
        "last_updated": "2016-02-26",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "MARIA",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "BUSINESS DIRECTOR",
        "authorized_official_telephone_number": "503-894-9005"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "OR",
            "license": "85696897",
            "primary": true
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "OR",
            "license": "85696897",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500646730",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "R167408",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rose City Urgent Care and Family Practice",
            "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 Feb 26, 2016; 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.