Evelyn M Brosnan, M.D.
Individual provider Active NPI Hematology & Oncology Physician · Portland, OR
NPI 1497098941 · NPPES record last updated Nov 4, 2019
Key facts
- NPI
- 1497098941
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Hematology & Oncology Physician 207RH0003X
- License
- MD192507 (OR)
- Practice address
- 4805 NE Glisan St Ste 11N
Portland, OR 97213-2933 - Phone
- (503) 215-1350
- NPI assigned
- Apr 3, 2013
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 12
Hospital & facility affiliations 13
Medicare Care Compare profile
- Specialty
- Hematology/Oncology
- Education
- University of Colorado School of Medicine, Denver, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Kaiser Foundation Health Plan of the Northwest
Providence Health and Services - Oregon
Practice addresses (Care Compare)
3600 N Interstate Ave
Portland, OR 97227-1106
Phone (800) 813-2000
4805 NE Glisan St
Portland, OR 97213-2933
Phone (503) 215-1111
Hospital & facility affiliations
- Providence Seaside Hospital
- Columbia Memorial Hospital
- Providence Portland Medical Center
- Adventist Health Tillamook
- Providence St Vincent Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in OR, WA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190802001354 | OR | Practitioner - Hematology/Oncology | 2668771825 | Reassigns benefits to 4 organizations |
| I20260514003946 | WA | Practitioner - Hematology/Oncology | 2668771825 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD192507 | OR | MD | Hematology & Oncology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Providence Health & Services Oregon | Current |
Accepting new patients | |
| Providence Health & Services Oregon | Current |
Accepting new patients | |
| Providence Health & Services Oregon | Current |
Accepting new patients | |
| Providence Health & Services - Oregon | Current | Accepting new patients | |
| Providence Health & Services - Oregon | Current |
Accepting new patients | |
| Providence Health & Services Oregon | Current |
Accepting new patients |
Locations
4805 NE Glisan St
Ste 11N
Portland, OR 97213
Phone (503) 215-1350
4805 NE Glisan St
Portland, OR 97213
Phone (503) 215-1111
725 S Wahanna Rd
Seaside, OR 97138
Phone (503) 717-7000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Hematology & Oncology Physician | 207RH0003X | MD192507 | OR | Yes |
Addresses
Primary practice location
4805 NE Glisan St Ste 11N
Portland, OR 97213-2933
Mailing address
PO Box 3158
Portland, OR 97208-3158
Phone (503) 215-6494
Other practice location 1
1 Medical Center Dr
DHMC
Lebanon, NH 03756-1000
Phone (603) 650-5000
Other providers in Portland, OR
- Brookside Dental-Sellwood, LLC
- Denise Broom
- David Sterling Broomfield
- Margaret Brophy
- Janice 503 Bropleh
- Michael Brosnan
- John Paul Brotzman
- Danielle Alison Brouillard
- Adam Packard Brounstein
- Shannon Marie Broussard-Bueno
All providers in Portland, OR · Hematology & Oncology Physician in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 4, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.