Individual provider Active NPI

Steven Gabriel Moylan, DO

  • Anesthesiology Physician
  • Portland, OR
National Provider Identifier
1518304559
Registry record updated Oct 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
DO177114 Issued in OR
Practice address
707 SW Washington St
Suite 700
Portland, OR 97205-3536
Phone
(503) 299-9906
Fax
(503) 225-9002
NPI assigned
May 31, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X VA
Anesthesiology Physician 207L00000X DO177114 OR Primary

Addresses

Primary practice location

707 SW Washington St
Suite 700
Portland, OR 97205-3536

Mailing address

PO Box 35147
#1801
Seattle, WA 98124-5147
Phone (503) 299-9906

Other identifiers 1

IdentifierTypeStateIssuer
500709831MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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

Enrollment IDStateProvider typePAC IDDetails
I20160803003108 OR Practitioner - Anesthesiology 8527200138 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kaiser Foundation Health Plan of the NorthwestGroup PAC ID 5799688230, 1,805 clinicians

Practice addresses (Care Compare)

10180 SE Sunnyside Rd
Clackamas, OR 97015-8970
Phone (800) 813-2000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
DO177114ORMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Apr 27, 2020 Accepting new patients
Oregon Anesthesiology Group PC Anesthesiology CurrentSince Aug 1, 2016 Accepting new patients
Kaiser Foundation Health Plan of the Northwest Anesthesiology CurrentSince Apr 27, 2020 Accepting new patients
Oag Trauma Services LLC Anesthesiology PastSince Aug 1, 2016 Accepting new patients

Locations

10180 SE Sunnyside Rd
Clackamas, OR 97015
Phone (503) 571-2880

10100 SE Sunnyside Rd
Clackamas, OR 97015
Phone (503) 571-2946

707 SW Washington St
Ste 700
Portland, OR 97205

7201 N Interstate Ave
Portland, OR 97217
Phone (503) 240-4051

1445 State St
Salem, OR 97301
Phone (503) 315-7338

2400 Lancaster Dr NE
Salem, OR 97305
Phone (503) 361-5400

1460 G St
Springfield, OR 97477
Phone (541) 431-0665

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1369958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539734400000",
    "number": "1518304559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 35147",
            "address_2": "#1801",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981245147",
            "telephone_number": "503-299-9906",
            "fax_number": "503-225-9002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "707 SW WASHINGTON ST",
            "address_2": "SUITE 700",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972053536",
            "telephone_number": "503-299-9906",
            "fax_number": "503-225-9002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOYLAN",
        "first_name": "STEVEN",
        "middle_name": "GABRIEL",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-05-31",
        "last_updated": "2018-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "VA",
            "license": null,
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "OR",
            "license": "DO177114",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500709831",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.