Individual provider Active NPI

Ilan Jose Rothman, MD

  • Anesthesiology Physician
  • Portland, OR
National Provider Identifier
1447440433
Registry record updated Sep 17, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
MD28510 Issued in OR
Practice address
120 NW 14TH Ave
Ste 300
Portland, OR 97209-2643
Phone
(503) 299-9906
Fax
(503) 225-9002
NPI assigned
Jul 26, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2009

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X LL17378 OR
Anesthesiology Physician 207L00000X MD28510 OR Primary

Addresses

Primary practice location

120 NW 14TH Ave
Ste 300
Portland, OR 97209-2643

Mailing address

PO Box 2040
Portland, OR 97208-2040
Phone (503) 299-9906

Other identifiers 3

IdentifierTypeStateIssuer
025298MedicaidOR
8524738MedicaidWA
P00695329OtherORRR MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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
I20081105000362 OR Practitioner - Anesthesiology 9032278098 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northwest Anesthesia Physicians PCGroup PAC ID 3274420138, 93 clinicians

Practice addresses (Care Compare)

1460 G St
Springfield, OR 97477-4112
Phone (541) 726-4402

3333 Riverbend Dr
Springfield, OR 97477-8800
Phone (541) 222-2300

3355 Riverbend Dr
Suite 110510
Springfield, OR 97477-8800
Phone (541) 868-9555

Hospital & facility affiliations

  • Sacred Heart Medical Center - Riverbend Hospital, Springfield, OR, CCN 380102

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
122560CAMDClinical Social Worker
MD28510ORMDAnesthesiology Physician
LL17378ORMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Northwest Anesthesia Physicians PC Anesthesiology CurrentSince Dec 6, 2021 Accepting new patients
Oregon Anesthesiology Group PC Anesthesiology PastSince Jul 25, 2019 Accepting new patients

Locations

1460 G St
Springfield, OR 97477
Phone (541) 431-0665

Organizations & group practices 3

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 2

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": "1185408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1253145600000",
    "number": "1447440433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2040",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972082040",
            "telephone_number": "503-299-9906",
            "fax_number": "503-225-9002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 NW 14TH AVE",
            "address_2": "STE 300",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972092643",
            "telephone_number": "503-299-9906",
            "fax_number": "503-225-9002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROTHMAN",
        "first_name": "ILAN",
        "middle_name": "JOSE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-26",
        "last_updated": "2009-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "OR",
            "license": "LL17378",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "OR",
            "license": "MD28510",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "025298",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8524738",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00695329",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.