NPIMap

Individual provider Active NPI

Eric Eugene Swiridoff, MD

  • Family Medicine Physician
  • Sandy, OR
National Provider Identifier
1467456053
Registry record updated Feb 16, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD18643 Issued in OR
Practice address
36860 Industrial Way
Sandy, OR 97055-7371
Phone
(503) 826-0206
Fax
(503) 826-0216
NPI assigned
Jun 10, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD18643 OR Primary

Addresses

Primary practice location

36860 Industrial Way
Sandy, OR 97055-7371

Mailing address

36860 Industrial Way
Sandy, OR 97055-7371
Phone (503) 826-0206

Other identifiers 1

IdentifierTypeStateIssuer
059092MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070626000154 OR Practitioner - Family Practice 2062511413 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Loma Linda University School of Medicine, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Legacy Clinics LLCGroup PAC ID 0244144004, 714 clinicians

Practice addresses (Care Compare)

1130 NW 22ND Ave
Suite 220
Portland, OR 97210-2969
Phone (503) 413-8988

36860 Industrial Way
Sandy, OR 97055-7371
Phone (503) 668-4117

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.62 of 100Reported as apm
Quality
77.21
Promoting interoperability
99.06
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Legacy Mount Hood Medical Center Current Accepting new patients
Legacy Mount Hood Medical Center CurrentSince Sep 10, 2020 Accepting new patients
Legacy Clinics LLC Family Medicine CurrentSince Apr 1, 2007 Accepting new patients
Legacy Clinics LLC CurrentSince Apr 1, 2007 Accepting new patients
County of Clackamas Office of County Auditor Past Accepting new patients

Locations

24800 SE Stark St
Gresham, OR 97030
Phone (503) 413-8407

24988 SE Stark St
Ste 220
Gresham, OR 97030
Phone (503) 674-1580

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

36860 Industrial Way
Sandy, OR 97055
Phone (503) 668-4117

Interoperability endpoints

  • Direct secure messaging: eswiridoff9228@direct.lhs.org

Organizations & group practices 5

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 8

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": "1118361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1297814400000",
    "number": "1467456053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36860 INDUSTRIAL WAY",
            "city": "SANDY",
            "state": "OR",
            "postal_code": "970557371",
            "telephone_number": "503-826-0206",
            "fax_number": "503-826-0216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36860 INDUSTRIAL WAY",
            "city": "SANDY",
            "state": "OR",
            "postal_code": "970557371",
            "telephone_number": "503-826-0206",
            "fax_number": "503-826-0216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SWIRIDOFF",
        "first_name": "ERIC",
        "middle_name": "EUGENE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-10",
        "last_updated": "2011-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "MD18643",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "059092",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sandy, OR

Sources for this page

Verify at the official NPI Registry.