Individual provider Active NPI

Shaun Lan, MD

  • Family Medicine Physician
  • Portland, OR
National Provider Identifier
1528224474
Registry record updated Sep 3, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
BP10029323 Issued in TX
Practice address
1130 NW 22ND Ave
Suite 220
Portland, OR 97210-2900
Phone
(503) 413-8988
NPI assigned
Jul 31, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X BP10029323 TX Primary

Addresses

Primary practice location

1130 NW 22ND Ave
Suite 220
Portland, OR 97210-2900

Mailing address

1130 NW 22ND Ave
Suite 220
Portland, OR 97210-2900
Phone (503) 413-8988

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, WA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20100709000049 OR Practitioner - Family Practice 2365574365 Reassigns benefits to 3 organizations
I20230626002974 WA Practitioner - Family Practice 2365574365 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Baylor College of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3550 N Interstate Ave
Portland, OR 97227-1196
Phone (800) 813-2000

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
BP10029323TXMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Jun 19, 2023 Accepting new patients
Kaiser Foundation Health Plan of the Northwest Family Medicine CurrentSince Jun 19, 2023 Accepting new patients
Kaiser Foundation Health Plan of the Northwest Family Medicine CurrentSince Jun 19, 2023 Accepting new patients
Legacy Good Samaritan Hospital and Medical Center Current Accepting new patients
Legacy Clinics LLC Family Medicine CurrentSince Jul 1, 2010 Accepting new patients

Locations

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

3550 N Interstate Ave
Portland, OR 97227
Phone (503) 285-9321

1130 NW 22nd Ave
Ste 220
Portland, OR 97210
Phone (503) 413-4134

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

1200 NW 23rd Ave
Portland, OR 97210
Phone (503) 413-7074

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

1230 7th Ave
Longview, WA 98632
Phone (360) 575-4801

7101 NE 137th Ave
Vancouver, WA 98682
Phone (360) 418-6000

Organizations & group practices 5

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": "1217462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1283472000000",
    "number": "1528224474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1130 NW 22ND AVE",
            "address_2": "SUITE 220",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972102900",
            "telephone_number": "503-413-8988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1130 NW 22ND AVE",
            "address_2": "SUITE 220",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972102900",
            "telephone_number": "503-413-8988"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAN",
        "first_name": "SHAUN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-31",
        "last_updated": "2010-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "BP10029323",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.