Individual provider Active NPI

Susan I Vangorder, CRNA

  • Certified Registered Nurse Anesthetist
  • Portland, OR
National Provider Identifier
1487653796
Registry record updated Sep 19, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Practice address
3181 SW Sam Jackson Park Road
Ohsu
Portland, OR 97239-3098
Phone
(503) 494-8014
Fax
(503) 494-2251
NPI assigned
Jul 19, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2007

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 0001131932 VA
Anesthesiology Physician 207L00000X 0024165997 VA
Certified Registered Nurse Anesthetist 367500000X OR Primary

Addresses

Primary practice location

3181 SW Sam Jackson Park Road
Ohsu
Portland, OR 97239-3098

Mailing address

3181 SW Sam Jackson Park Road
Ohsu
Portland, OR 97239-3098
Phone (503) 494-8014

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070308000640 OR Practitioner - Certified Registered Nurse Anesthetist (Crna) 3173506961 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University Anesthesiology Associates LLCGroup PAC ID 6901702869, 239 clinicians

Practice addresses (Care Compare)

3181 SW Sam Jackson Park Rd
Portland, OR 97239-3011
Phone (503) 494-7641

3181 Swsam Jackson Park Rd
Portland, OR 97239-3011

3303 S Bond Ave
Portland, OR 97239-4501
Phone (503) 494-7641

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
98.65
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0001131932VAMDAnesthesiology Physician
0024165997VAMDAnesthesiology Physician
200660019CRNAORMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
University Anesthesiology Associates, LLC Anesthesiology CurrentSince Mar 20, 2010 Accepting new patients
Anesthesia Associates Northwest LLC Anesthesiology CurrentSince Oct 18, 2009 Accepting new patients
Anesthesia Associates LTD. Anesthesiology Past Accepting new patients

Locations

3181 SW Sam Jackson Park Rd
Portland, OR 97239
Phone (503) 494-5674

120 NW 14th Ave
Ste 200
Portland, OR 97209
Phone (503) 771-1883

Interoperability endpoints

  • Direct secure messaging: svangordercrna21961@direct.ohsu.edu

Organizations & group practices 3

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 1

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": "1121731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1190160000000",
    "number": "1487653796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3181 SW SAM JACKSON PARK ROAD",
            "address_2": "OHSU",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972393098",
            "telephone_number": "503-494-8014",
            "fax_number": "503-494-2251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3181 SW SAM JACKSON PARK ROAD",
            "address_2": "OHSU",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972393098",
            "telephone_number": "503-494-8014",
            "fax_number": "503-494-2251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANGORDER",
        "first_name": "SUSAN",
        "middle_name": "I",
        "name_prefix": "Ms.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-19",
        "last_updated": "2007-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "VA",
            "license": "0001131932",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "VA",
            "license": "0024165997",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "OR",
            "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 Sep 19, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.