NPIMap

Organization Active NPI

Portland Clinic

Doing business as Roger E. Alberty, M.D. Surgical Center

  • Ambulatory Surgical Clinic/Center
  • Tigard, OR
National Provider Identifier
1508040486
Registry record updated Oct 26, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
PORTLAND CLINIC
Doing business as
Roger E. Alberty, M.D. Surgical Center
Practice address
9100 SW Oleson Road
Tigard, OR 97223
Phone
(503) 445-9066
NPI assigned
Dec 27, 2007
Last updated
Oct 26, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
PORTLAND CLINICAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 26, 2020

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

Authorized official

Name
Mr. Dick Clark
Title
Chief Executive Officer
Phone
(503) 221-0161

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X Primary

Addresses

Primary practice location

9100 SW Oleson Road
Tigard, OR 97223

Mailing address

800 SW 13TH Ave
Portland, OR 97205-1902
Phone (503) 221-0161

Other names 1

  • Roger E. Alberty, M.D. Surgical Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031118000101 OR Part B Supplier - Clinic/Group Practice 8224942867 Receives reassigned benefits from 114 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Beaverton, OR; Portland, OR; Tigard, OR
O20080208000555 OR Part B Supplier - Ambulatory Surgical Center 8224942867 Practice locations: Tigard, OR

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Portland ClinicCCN 38C0001087
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
38D1080786Portland Clinic-Alberty Surgical Center, the9100 SW Oleson Rd, Tigard, OR 97223Certificate of waiverFeb 29, 2028

National Provider Directory

National Provider Directory
Part of
Portland Clinic LLP

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 18

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.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1198713600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603670400000",
    "number": "1508040486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 SW 13TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972051902",
            "telephone_number": "503-221-0161",
            "fax_number": "503-221-4451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9100 SW OLESON ROAD",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "97223",
            "telephone_number": "503-445-9066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTLAND CLINIC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PORTLAND CLINIC",
        "enumeration_date": "2007-12-27",
        "last_updated": "2020-10-26",
        "certification_date": "2020-10-26",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "DICK",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "503-221-0161",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Roger E. Alberty, M.D. Surgical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Roger E. Alberty, M.D. Surgical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tigard, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.