NPIMap

Individual provider Active NPI

Tracy Bazan, MD

  • Neuromuscular Medicine (Psychiatry & Neurology) Physician
  • Portland, OR
National Provider Identifier
1487073789
Registry record updated Nov 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neuromuscular Medicine (Psychiatry & Neurology) PhysicianTaxonomy code 2084N0008X
License
MD187129 Issued in OR
Practice address
5050 NE Hoyt St Ste 315
Portland, OR 97213-2982
Phone
(503) 215-8580
NPI assigned
Apr 15, 2014
Last updated
Nov 25, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X MD187129 OR
Neuromuscular Medicine (Psychiatry & Neurology) Physician 2084N0008X MD187129 OR Primary

Addresses

Primary practice location

5050 NE Hoyt St Ste 315
Portland, OR 97213-2982

Mailing address

PO Box 3158
Portland, OR 97208-3158
Phone (503) 215-6494

Other practice location 1

3181 SW Sam Jackson Park Rd
Portland, OR 97239-3011
Phone (503) 494-8211

Other practice location 2

10330 SE 32nd Ave Ste 226
Milwaukie, OR 97222-6699
Phone (503) 513-8020

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
I20190919001910 OR Practitioner - Neurology 0547489841 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
New York Medical College, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

4805 NE Glisan St
Portland, OR 97213-2933

5050 NE Hoyt St
Portland, OR 97213-2982

5050 NE Hoyt St
Suite 454
Portland, OR 97213-2984
Phone (503) 215-6405

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Skin biopsy18

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD187129ORMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services - Oregon CurrentSince Sep 1, 2019 Accepting new patients
Providence Health & Services Oregon Current Accepting new patients
Providence Health & Services - Oregon CurrentSince Sep 1, 2019 Accepting new patients
Providence Health & Services - Oregon CurrentSince Sep 1, 2019 Accepting new patients
Providence Health & Services Oregon Current Accepting new patients
Providence Health & Services Oregon CurrentSince Sep 1, 2019 Accepting new patients
Providence Health & Services Oregon CurrentSince Sep 1, 2019 Accepting new patients
Providence Health & Services Oregon CurrentSince Sep 1, 2019 Accepting new patients
Providence Health & Services Oregon CurrentSince Sep 1, 2019 Accepting new patients
Providence Health & Services - Oregon CurrentSince Sep 1, 2019 Accepting new patients
Providence Health & Services - Oregon Past Accepting new patients

Locations

9290 SE Sunnybrook Blvd
Ste 210
Clackamas, OR 97015
Phone (503) 216-7960

10330 SE 32nd Ave
Ste 226
Milwaukie, OR 97222
Phone (503) 513-8020

1001 N Providence Dr
Newberg, OR 97132
Phone (503) 216-1538

10150 SE 32nd Ave
Portland, OR 97222
Phone (503) 215-4202

4805 NE Glisan St
Portland, OR 97213
Phone (503) 215-1111

5050 NE Hoyt St
Ste 240
Portland, OR 97213
Phone (503) 215-6480

5050 NE Hoyt St
Ste 315
Portland, OR 97213
Phone (503) 215-8580

5050 NE Hoyt St
Ste 454
Portland, OR 97213
Phone (503) 215-6405

5050 NE Hoyt St
Ste 615
Portland, OR 97213
Phone (503) 215-8580

Organizations & group practices 11

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.

Hospital & facility affiliations 7

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": "1397520000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669334400000",
    "number": "1487073789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3158",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083158",
            "telephone_number": "503-215-6494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5050 NE HOYT ST STE 315",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972132982",
            "telephone_number": "503-215-8580"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3181 SW Sam Jackson Park Rd",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972393011",
            "country_code": "US",
            "telephone_number": "503-494-8211",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10330 SE 32nd Ave Ste 226",
            "address_purpose": "LOCATION",
            "city": "Milwaukie",
            "state": "OR",
            "postal_code": "972226699",
            "country_code": "US",
            "telephone_number": "503-513-8020",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BAZAN",
        "first_name": "TRACY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-04-15",
        "last_updated": "2022-11-25",
        "certification_date": "2022-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "OR",
            "license": "MD187129",
            "primary": false
        },
        {
            "code": "2084N0008X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neuromuscular Medicine",
            "state": "OR",
            "license": "MD187129",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.