NPIMap

Individual provider Active NPI

Marco Pocholo Rigor Valencia, M.D.

  • Family Medicine Physician
  • Lake Oswego, OR
National Provider Identifier
1487966107
Registry record updated Aug 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD185193 Issued in OR
Practice address
412 A Ave Ste 200
Lake Oswego, OR 97034-3078
Phone
(503) 635-2496
NPI assigned
Jul 10, 2010
Last updated
Aug 7, 2023By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 7, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD60328795 WA
Family Medicine Physician 207Q00000X MD185193 OR Primary

Addresses

Primary practice location

412 A Ave Ste 200
Lake Oswego, OR 97034-3078

Mailing address

412 A Ave Ste 200
Lake Oswego, OR 97034-3078
Phone (503) 635-2496

Other identifiers 2

IdentifierTypeStateIssuer
G8919708OtherWAMEDICARE
0311916OtherWAL&I

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
I20190221001158 OR Practitioner - Family Practice 2365683968 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Legacy Meridian Park HospitalGroup PAC ID 5092609842, 113 clinicians

Practice addresses (Care Compare)

412 A Ave
Lake Oswego, OR 97034-3075
Phone (503) 635-2496

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD60328795WAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Jan 6, 2019 Accepting new patients
Legacy Meridian Park Hospital CurrentSince Aug 7, 2023 Accepting new patients
Legacy Meridian Park Hospital CurrentSince Aug 7, 2023 Accepting new patients
Kaiser Foundation Health Plan of the Northwest Family Medicine Current Accepting new patients
Kaiser Foundation Health Plan of the Northwest Family Medicine CurrentSince Jan 6, 2019 Accepting new patients

Locations

10100 SE Sunnyside Rd
Clackamas, OR 97015
Phone (503) 571-2946

412 A Ave
Ste 200
Lake Oswego, OR 97034
Phone 5036352496 ext. 7458

412 A Ave
Lake Oswego, OR 97034
Phone (503) 635-2496

1919 NW Lovejoy St
Portland, OR 97209
Phone (503) 415-5600

2400 Lancaster Dr NE
Salem, OR 97305
Phone (503) 361-5400

19300 SW 65th Ave
Tualatin, OR 97062
Phone (503) 692-1212

Organizations & group practices 5

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 9

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": "1278720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691366400000",
    "number": "1487966107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "412 A AVE STE 200",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970343078",
            "telephone_number": "503-635-2496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "412 A AVE STE 200",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970343078",
            "telephone_number": "503-635-2496"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VALENCIA",
        "first_name": "MARCO POCHOLO",
        "middle_name": "RIGOR",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-07-10",
        "last_updated": "2023-08-07",
        "certification_date": "2023-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD60328795",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "MD185193",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "G8919708",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L&I",
            "identifier": "0311916",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Oswego, OR

Sources for this page

Verify at the official NPI Registry.