NPIMap

Organization Active NPI

Baseline Vision Clinic LLC

  • Optometrist
  • Hillsboro, OR
National Provider Identifier
1548472780
Registry record updated May 4, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1445ATI Issued in OR
Legal business name
BASELINE VISION CLINIC LLC
Practice address
527 SE Baseline St. Ste B
Hillsboro, OR 97123
Phone
(503) 648-8327
Fax
(503) 648-8378
NPI assigned
May 3, 2007
Last updated
May 4, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 4, 2018

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

Authorized official

Name
Joan Ploem Miller, ODNPI 1194882704
Title
Owner Optometrist
Phone
(503) 648-8328

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1445ATI OR Primary

Addresses

Primary practice location

527 SE Baseline St. Ste B
Hillsboro, OR 97123

Mailing address

527 SE Baseline St
Ste B
Hillsboro, OR 97123-4149
Phone (503) 648-8328

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180504001759 OR Part B Supplier - Clinic/Group Practice 5597029215 Receives reassigned benefits from 2 practitioners
Practice locations: Hillsboro, OR

National Provider Directory

National Provider Directory

Locations

527 SE Baseline St
Ste B
Hillsboro, OR 97123
Phone (503) 648-8327

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1525392000000",
    "number": "1548472780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "527 SE BASELINE ST",
            "address_2": "STE B",
            "city": "HILLSBORO",
            "state": "OR",
            "postal_code": "971234149",
            "telephone_number": "503-648-8328",
            "fax_number": "503-648-8378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "527 SE BASELINE ST. STE B",
            "city": "HILLSBORO",
            "state": "OR",
            "postal_code": "97123",
            "telephone_number": "503-648-8327",
            "fax_number": "503-648-8378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BASELINE VISION CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2018-05-04",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "JOAN",
        "authorized_official_middle_name": "PLOEM",
        "authorized_official_title_or_position": "OWNER OPTOMETRIST",
        "authorized_official_telephone_number": "503-648-8328",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "1445ATI",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hillsboro, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.