Individual provider Active NPI

Julian Ponsetto, MD

  • Pediatrics Physician
  • Portland, OR
National Provider Identifier
1427549187
Registry record updated Nov 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
MD210274 Issued in OR
Practice address
3181 SW Sam Jackson Park Rd
Portland, OR 97239-3011
Phone
(503) 418-5700
Fax
(503) 418-5704
NPI assigned
May 29, 2018
Last updated
Nov 22, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X MD210274 OR Primary
Pediatrics Physician 208000000X 275463 MA

Addresses

Primary practice location

3181 SW Sam Jackson Park Rd
Portland, OR 97239-3011

Mailing address

3181 SW Sam Jackson Park Rd
Portland, OR 97239-3011
Phone (503) 418-5700

Other practice location 1

2870 SW Cedar Hills Blvd
Beaverton, OR 97005-1354
Phone (503) 646-9222

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA, WA, OR3 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20210610002706 MA Practitioner - Pediatric Medicine 8426305160 Reassigns benefits to 1 organization
I20230808002493 WA Practitioner - Pediatric Medicine 8426305160 Reassigns benefits to 1 organization
I20230808003314 OR Practitioner - Pediatric Medicine 8426305160 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD210274ORMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University Professional Services CurrentSince Oct 1, 2023 Accepting new patients
University Professional Services CurrentSince Oct 1, 2023 Accepting new patients
Southcoast Physicians Group, Inc. CurrentSince Jun 8, 2021 Accepting new patients
University Professional Services Current Accepting new patients
Southcoast Physicians Group, Inc. CurrentSince Jun 8, 2021 Accepting new patients
Legacy Clinics LLC CurrentSince Jun 27, 2023 Accepting new patients
University Professional Services Pediatrics Past Accepting new patients
The Oregon Clinic, PC Past Accepting new patients
Oregon Health & Science University Past Accepting new patients
Legacy Clinics LLC PastSince Jun 27, 2023 Accepting new patients

Locations

534 Prospect St
Fall River, MA 02720
Phone (508) 679-7766

49 State Rd
North Dartmouth, MA 02747
Phone (508) 973-9240

15700 SW Greystone Ct
Beaverton, OR 97006
Phone (503) 203-1000

2870 SW Cedar Hills Blvd
Beaverton, OR 97005
Phone (503) 646-9222

1130 NW 22nd Ave
Ste 220
Portland, OR 97210
Phone (503) 413-4134

1919 NW Lovejoy St
Portland, OR 97209
Phone (503) 415-5600

3181 SW Sam Jackson Park Rd
Portland, OR 97239
Phone (503) 494-5674

200 NE Mother Joseph Pl
Ste 410
Vancouver, WA 98664
Phone (503) 413-3580

305 SE Chkalov Dr
Ste 170
Vancouver, WA 98683
Phone (360) 799-3912

3425 SE 192nd Ave
Ste 106
Vancouver, WA 98683
Phone (360) 205-2960

Interoperability endpoints

  • Direct secure messaging: jponsetto102903@direct.ohsu.edu

Organizations & group practices 10

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1527552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700611200000",
    "number": "1427549187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3181 SW SAM JACKSON PARK RD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972393011",
            "telephone_number": "503-418-5700",
            "fax_number": "503-418-5704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3181 SW SAM JACKSON PARK RD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972393011",
            "telephone_number": "503-418-5700",
            "fax_number": "503-418-5704"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2870 SW Cedar Hills Blvd",
            "address_purpose": "LOCATION",
            "city": "Beaverton",
            "state": "OR",
            "postal_code": "970051354",
            "country_code": "US",
            "telephone_number": "503-646-9222",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PONSETTO",
        "first_name": "JULIAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-05-29",
        "last_updated": "2023-11-22",
        "certification_date": "2023-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OR",
            "license": "MD210274",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MA",
            "license": "275463",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.