Active NPI
Tara Gardner-Brown, NP-C
- Family Nurse Practitioner
- Portland, OR
National Provider Identifier
1508830571
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 201250044NP
- Practice address
- 1880 SW 6TH Ave Ste 200
Portland State University
Portland, OR 97201-5204 - Phone
- (503) 725-2800
- NPI assigned
- Feb 15, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 201250044NP | OR | Primary |
Addresses
Primary practice location
1880 SW 6TH Ave Ste 200
Portland State University
Portland, OR 97201-5204
Mailing address
1880 SW 6TH Ave Ste 200
Portland State University
Portland, OR 97201-5204
Phone (503) 725-2800
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 806098000 | Medicaid | ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Portland State University Center for Student Health and Counseling | Past | Accepting new patients | |
| Massachusetts Institute of Technology | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Student Health Clinic/Center
- Portland, OR
- NPI 1215072228
-
dba MIT Health
- Multi-Specialty Clinic/Center
- Cambridge, MA
- NPI 1346308723
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139961600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1466380800000",
"number": "1508830571",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1880 SW 6TH AVE STE 200",
"address_2": "PORTLAND STATE UNIVERSITY",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972015204",
"telephone_number": "503-725-2800"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1880 SW 6TH AVE STE 200",
"address_2": "PORTLAND STATE UNIVERSITY",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972015204",
"telephone_number": "503-725-2800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GARDNER-BROWN",
"first_name": "TARA",
"credential": "NP-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-02-15",
"last_updated": "2016-06-20",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "OR",
"license": "201250044NP",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "806098000",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.