Providence Health & Services - Oregon

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

PROVIDENCE HEALTH & SERVICES - OREGON

Practice address

16180 SE Sunnyside Road
Suite 102
Happy Valley, OR 97015-6302

Phone

(503) 582-4900

NPI assigned

Sep 17, 2008

Organization subpart

No

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

Authorized official

Name

Donald W Anderson Jr.

Title

Assistant Secretary Enrollment

Phone

(425) 358-9786

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 2

• PROVIDENCE MEDICAL GROUP Doing business as
• Providence Medical Group Happy Valley Doing business as

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Locations

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Gabrielle Simone Alexander, M.D

  • Obstetrics & Gynecology Physician
  • Portland, OR
  • NPI 1124480413
  NPD
• Enrique Barrera Jr., FNP

  • Family Nurse Practitioner
  • Tigard, OR
  • NPI 1528337201
  NPD
• Kenric Brion Craver, PA

  • Physician Assistant
  • Tigard, OR
  • NPI 1144414046
  NPD
• Alex K Jenkins, MD

  • Psychiatry Physician
  • Portland, OR
  • NPI 1306877535
  NPD
• Ruth Janan Markee, MD

  • Hospitalist Physician
  • Portland, OR
  • NPI 1821171018
  NPD
• Kari T Mazur, MD

  • Hospitalist Physician
  • Portland, OR
  • NPI 1871797340
  NPD

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

{
    "created_epoch": "1221609600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1751241600000",
    "number": "1508015348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31001 - 4180",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911104180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16180 SE SUNNYSIDE ROAD",
            "address_2": "SUITE 102",
            "city": "HAPPY VALLEY",
            "state": "OR",
            "postal_code": "970156302",
            "telephone_number": "503-582-4900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH & SERVICES - OREGON",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-17",
        "last_updated": "2025-06-30",
        "certification_date": "2025-06-30",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY ENROLLMENT",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500612832",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PROVIDENCE MEDICAL GROUP",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Providence Medical Group Happy Valley",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Premere Rehab, LLC
• Christine Price, COTA
• Pride Transit LLC
• Providence Health & Services - Oregon
• Providence Health & Services - Oregon
• PTSC Group, Inc.
• Vivian Lee Puga
• Ancuta Lavinia Radutiu, RN
• Akanksha Rajeurs, M.D.
• Rajesh Gade Rao, PA-C

• Family Medicine Physician in Happy Valley, OR
• Providers in Happy Valley, OR by specialty
• Family Medicine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.