Active NPI
Gabriel Tucker Bertell, PHARMD
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- Gresham, OR
National Provider Identifier
1467725432
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- License
- RPH-0011399
- Practice address
- 2497 SE Burnside Rd
Gresham, OR 97080-1246 - Phone
- (503) 669-4233
- NPI assigned
- Feb 21, 2012
- Last updated
- Apr 27, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RPH-0011399 | OR | |
| Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | 1835P0018X | RPH-0011399 | OR | Primary |
Addresses
Primary practice location
2497 SE Burnside Rd
Gresham, OR 97080-1246
Mailing address
2497 NE Burnside Rd
Gresham, OR 97080
Phone (503) 669-4233
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RPH-0011399 | OR | MD | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fred Meyer Stores Inc | Past | Accepting new patients | |
| Fred Meyer Stores Inc. | Past | Accepting new patients |
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, 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": "1329782400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1493251200000",
"number": "1467725432",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2497 NE BURNSIDE RD",
"city": "GRESHAM",
"state": "OR",
"postal_code": "97080",
"telephone_number": "503-669-4233"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2497 SE BURNSIDE RD",
"city": "GRESHAM",
"state": "OR",
"postal_code": "970801246",
"telephone_number": "503-669-4233"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERTELL",
"first_name": "GABRIEL",
"middle_name": "TUCKER",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-02-21",
"last_updated": "2017-04-27",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OR",
"license": "RPH-0011399",
"primary": false
},
{
"code": "1835P0018X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
"state": "OR",
"license": "RPH-0011399",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gresham, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.