Active NPI
Tina Marie Penman, AUD
- Audiologist
- Portland, OR
National Provider Identifier
1528367372
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Audiologist
- License
- 023459
- Practice address
- 3710 SW US Veterans Hospital Rd
Mailcode: Ncrar, Building 104, Level P5, Office P5F-175
Portland, OR 97239-2964 - Phone
- (503) 220-8262
- NPI assigned
- Mar 18, 2011
- 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 |
|---|---|---|---|---|
| Audiologist | 231H00000X | 023459 | OR | Primary |
Addresses
Primary practice location
3710 SW US Veterans Hospital Rd
Mailcode: Ncrar, Building 104, Level P5, Office P5F-175
Portland, OR 97239-2964
Mailing address
3710 SW US Veterans Hospital Rd
Mailcode: Ncrar, Building 104, Level P5, Office P5F-175
Portland, OR 97239-2964
Phone (503) 220-8262
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 023459 | Other | OR | STATE OF OREGON |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 023459 | OR | MD | Audiologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1300406400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1335398400000",
"number": "1528367372",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3710 SW US VETERANS HOSPITAL RD",
"address_2": "MAILCODE: NCRAR, BUILDING 104, LEVEL P5, OFFICE P5F-175",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972392964",
"telephone_number": "503-220-8262"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3710 SW US VETERANS HOSPITAL RD",
"address_2": "MAILCODE: NCRAR, BUILDING 104, LEVEL P5, OFFICE P5F-175",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972392964",
"telephone_number": "503-220-8262"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENMAN",
"first_name": "TINA",
"middle_name": "MARIE",
"credential": "AUD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-03-18",
"last_updated": "2012-04-26",
"status": "A"
},
"taxonomies": [
{
"code": "231H00000X",
"taxonomy_group": "",
"desc": "Audiologist",
"state": "OR",
"license": "023459",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE OF OREGON",
"identifier": "023459",
"state": "OR"
}
],
"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 Apr 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.