NPIMap

Individual provider Active NPI

Amy Michele Tubay, M.D.

  • Family Medicine Physician
  • Portland, OR
National Provider Identifier
1548202658
Registry record updated Aug 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD204185 Issued in OR
Practice address
4411 SW Vermont St
Portland, OR 97219-1020
Phone
(503) 494-9992
NPI assigned
Jun 12, 2006
Last updated
Aug 20, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD204185 OR Primary
Family Medicine Physician 207Q00000X 0052486 CO

Addresses

Primary practice location

4411 SW Vermont St
Portland, OR 97219-1020

Mailing address

4411 SW Vermont St
Portland, OR 97219-1020
Phone (503) 494-9992

Other identifiers 1

IdentifierTypeStateIssuer
29459303MedicaidCO

Other names 1

  • Amy Michele Tanner Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210804004351 OR Practitioner - Family Practice 6406854074 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Emory University School of Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
University Professional ServicesGroup PAC ID 4880760107, 1,683 clinicians

Practice addresses (Care Compare)

3303 S Bond Ave
Portland, OR 97239-4501
Phone (503) 494-8311

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0052486COMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University Professional Services CurrentSince Aug 1, 2021 Accepting new patients
University Professional Services CurrentSince Aug 1, 2021 Accepting new patients
Oregon Health & Science University Current Accepting new patients
Oregon Health & Science University CurrentSince Aug 1, 2021 Accepting new patients
Oregon Health & Science University CurrentSince Aug 1, 2021 Accepting new patients
University Professional Services Past Accepting new patients
University of Utah Adult Services PastSince Jan 1, 2026 Accepting new patients

Locations

15700 SW Greystone Ct
Beaverton, OR 97006
Phone (503) 203-1000

3181 SW Sam Jackson Park Rd
Portland, OR 97239
Phone (503) 494-5674

3303 S Bond Ave
Portland, OR 97239
Phone (503) 494-3151

3930 SE Division St
Portland, OR 97202
Phone (503) 418-3900

4212 SE Division St
Ste 150
Portland, OR 97206
Phone (503) 418-1500

4411 SW Vermont St
Portland, OR 97219
Phone (503) 494-9992

Interoperability endpoints

  • Direct secure messaging: atubay135328@direct.ohsu.edu

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629417600000",
    "number": "1548202658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4411 SW VERMONT ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972191020",
            "telephone_number": "503-494-9992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4411 SW VERMONT ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972191020",
            "telephone_number": "503-494-9992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TUBAY",
        "first_name": "AMY",
        "middle_name": "MICHELE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-12",
        "last_updated": "2021-08-20",
        "certification_date": "2021-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "MD204185",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "0052486",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "29459303",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMY",
            "last_name": "TANNER",
            "middle_name": "MICHELE",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.