NPIMap

Organization Active NPI

Pacific Medical Group, PC

  • Clinic/Center
  • Lake Oswego, OR
National Provider Identifier
1477636561
Registry record updated Nov 20, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
PACIFIC MEDICAL GROUP, PC
Practice address
6 Centerpointe Drive, Ste 200
Lake Oswego, OR 97035
Phone
(503) 234-6381
Fax
(503) 234-8151
NPI assigned
Oct 23, 2006
Last updated
Nov 20, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2007

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

Authorized official

Name
Dr. Susan M Clack, MDNPI 1669424917
Title
Ceo
Phone
(503) 598-2000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X OR Primary

Addresses

Primary practice location

6 Centerpointe Drive, Ste 200
Lake Oswego, OR 97035

Mailing address

6 Centerpointe Dr Ste 200
Lake Oswego, OR 97035-8660
Phone (503) 234-6381

Other identifiers 6

IdentifierTypeStateIssuer
230589MedicaidOR
CC6737OtherORRR MEDICARE
230547MedicaidOR
230549MedicaidOR
230548MedicaidOR
230550MedicaidOR

National Provider Directory

National Provider Directory

Locations

1185 S Elm St
Canby, OR 97013
Phone (503) 416-4547

6 Centerpointe Dr
Ste 200
Lake Oswego, OR 97035
Phone (503) 797-2268

6445 N Greeley Ave
Portland, OR 97217
Phone (503) 283-6607

Interoperability endpoints

  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.61288

Practitioners & affiliated clinicians

Practitioners 58

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 58

NPI Registry JSON

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

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1195516800000",
    "number": "1477636561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 CENTERPOINTE DR STE 200",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970358660",
            "telephone_number": "503-234-6381",
            "fax_number": "503-234-8151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 CENTERPOINTE DRIVE, STE 200",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "97035",
            "telephone_number": "503-234-6381",
            "fax_number": "503-234-8151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC MEDICAL GROUP, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-23",
        "last_updated": "2007-11-20",
        "status": "A",
        "authorized_official_last_name": "CLACK",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "503-598-2000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "OR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "230589",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "CC6737",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "230547",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "230549",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "230548",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "230550",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Oswego, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.