Individual provider Active NPI

Andrea J Young, MD

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Portland, OR
National Provider Identifier
1437174489
Registry record updated Aug 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X
License
MD189771 Issued in OR
Practice address
10000 SE Main St Ste 224
Portland, OR 97216-2469
Phone
(503) 261-6961
Fax
(503) 261-6959
NPI assigned
Jul 12, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X MD00045467 WA
Orthopaedic Surgery Physician 207X00000X MD189771 OR
Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X MD00045467 WA
Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X MD189771 OR Primary

Addresses

Primary practice location

10000 SE Main St Ste 224
Portland, OR 97216-2469

Mailing address

10000 SE Main St Ste 224
Portland, OR 97216-2469
Phone (503) 261-6961

Other practice location 1

1615 Delaware St
Longview, WA 98632-2367
Phone (360) 414-5750

Other identifiers 1

IdentifierTypeStateIssuer
1010353MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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 1

Enrollment IDStateProvider typePAC IDDetails
I20051004001162 WA Practitioner - Orthopedic SurgeryPractitioner - Sports Medicine 1759350556 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
99.11 of 100Reported as apm
Quality
84.29
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Peacehealth CurrentSince Aug 1, 2011 Accepting new patients
University Professional Services Current Accepting new patients

Locations

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

10000 SE Main St
Ste 224
Portland, OR 97216
Phone (503) 261-6961

10123 SE Market St
Portland, OR 97216
Phone (503) 251-6355

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

1615 Delaware St
Longview, WA 98632
Phone (360) 363-4818

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724716800000",
    "number": "1437174489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10000 SE MAIN ST STE 224",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972162469",
            "telephone_number": "503-261-6961",
            "fax_number": "503-261-6959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10000 SE MAIN ST STE 224",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972162469",
            "telephone_number": "503-261-6961",
            "fax_number": "503-261-6959"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1615 Delaware St",
            "address_purpose": "LOCATION",
            "city": "Longview",
            "state": "WA",
            "postal_code": "986322367",
            "country_code": "US",
            "telephone_number": "360-414-5750",
            "fax_number": "360-414-5763",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "YOUNG",
        "first_name": "ANDREA",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-12",
        "last_updated": "2024-08-27",
        "certification_date": "2024-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "WA",
            "license": "MD00045467",
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "OR",
            "license": "MD189771",
            "primary": false
        },
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "WA",
            "license": "MD00045467",
            "primary": false
        },
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "OR",
            "license": "MD189771",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1010353",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.