Azadeh Rezvan, M.D.

Primary specialty

Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) PhysicianTaxonomy code 207VF0040X

License

MD171989 Issued in OR

Practice address

10100 SE Sunnyside Rd
Mt Talert Medical Office, Division of Urogynecology
Clackamas, OR 97015-8970

Phone

(503) 652-2880

NPI assigned

Aug 6, 2008

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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

{
    "created_epoch": "1217980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1440460800000",
    "number": "1508022781",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10100 SE SUNNYSIDE RD. MT TALBERT MEDICAL OFFICE,",
            "address_2": "DEPARTMENT OF OB/GYN, DIVISION OF UROGYNECOLOGY",
            "city": "CLACKAMAS",
            "state": "OR",
            "postal_code": "97015",
            "telephone_number": "503-652-2880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10100 SE SUNNYSIDE RD",
            "address_2": "MT TALERT MEDICAL OFFICE, DIVISION OF UROGYNECOLOGY",
            "city": "CLACKAMAS",
            "state": "OR",
            "postal_code": "970158970",
            "telephone_number": "503-652-2880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REZVAN",
        "first_name": "AZADEH",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-08-06",
        "last_updated": "2015-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207VF0040X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery",
            "state": "OR",
            "license": "MD171989",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Susan Schaumburg Restic, DMD
• Jonathan Allyn Rettmann, M.D.
• Reviance Portland, LLC
• Christina Reyes-Fimbres, AUD
• Fern Jennifer G Reyes, MPH, RD,
• Natasha Ladane Rezvani, MD
• George David Rheaume, DC,DABCO,CCPS
• Rhodes Chiropractic Clackamas LLC
• John Patrick Richards II, MD
• Samantha Ellen Richards, MS CCC-SLP

• Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician in Clackamas, OR
• Providers in Clackamas, OR by specialty
• Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.