Active NPI
Taylor Park
- Student in an Organized Health Care Education/Training Program
- Portland, OR
National Provider Identifier
1477254340
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 1015 NW 22ND Ave
Portland, OR 97210-3025 - Phone
- (503) 413-7711
- NPI assigned
- Mar 16, 2023
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Primary |
Addresses
Primary practice location
1015 NW 22ND Ave
Portland, OR 97210-3025
Mailing address
1015 NW 22ND Ave
Portland, OR 97210-3025
Phone (503) 413-7711
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240502003388 | OR | Order and Referring Only - Internal Medicine | 6002256344 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1678924800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1713139200000",
"number": "1477254340",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1015 NW 22ND AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972103025",
"telephone_number": "503-413-7711"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1015 NW 22ND AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972103025",
"telephone_number": "503-413-7711"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "TAYLOR",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-03-16",
"last_updated": "2024-04-15",
"certification_date": "2024-04-15",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.