Reviance Portland, LLC

Primary specialty

Plastic Surgery Within the Head and Neck (Plastic Surgery) PhysicianTaxonomy code 2082S0099X

Legal business name

REVIANCE PORTLAND, LLC

Practice address

9280 SE Sunnybrook Blvd Ste 301
Clackamas, OR 97015-9353

Phone

(503) 953-1230

NPI assigned

Aug 26, 2022

Last updated

Aug 26, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

James Chan, MDNPI 1972543106

Title

Owner

Phone

(503) 953-1230

Specialties & licenses 1

Addresses

Locations

Practitioners 3

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.

• James Chan, MD

  • Otolaryngology/Facial Plastic Surgery Physician
  • Clackamas, OR
  • NPI 1972543106
  NPD Authorized official
• Valerie Rose Ing, DO

  • Sleep Medicine (Internal Medicine) Physician
  • Clackamas, OR
  • NPI 1356743041
  NPD
• Robert Lee Roberts, D.O.

  • Otolaryngology/Facial Plastic Surgery Physician
  • Clackamas, OR
  • NPI 1649280371
  NPD

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

{
    "created_epoch": "1661472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661472000000",
    "number": "1497474993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9280 SE SUNNYBROOK BLVD STE 301",
            "city": "CLACKAMAS",
            "state": "OR",
            "postal_code": "970159353",
            "telephone_number": "503-953-1230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9280 SE SUNNYBROOK BLVD STE 301",
            "city": "CLACKAMAS",
            "state": "OR",
            "postal_code": "970159353",
            "telephone_number": "503-953-1230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIANCE PORTLAND, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-26",
        "last_updated": "2022-08-26",
        "certification_date": "2022-08-25",
        "status": "A",
        "authorized_official_last_name": "CHAN",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-953-1230",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2082S0099X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Plastic Surgery, Plastic Surgery Within the Head and Neck",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heather Brooks Rensmith, LCSW
• Tamie Resare
• John William Reski, O.D.
• Susan Schaumburg Restic, DMD
• Jonathan Allyn Rettmann, M.D.
• Christina Reyes-Fimbres, AUD
• Fern Jennifer G Reyes, MPH, RD,
• Azadeh Rezvan, M.D.
• Natasha Ladane Rezvani, MD
• George David Rheaume, DC,DABCO,CCPS

• Plastic Surgery Physician in Clackamas, OR
• Providers in Clackamas, OR by specialty
• Plastic Surgery Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2022; 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.