NPIMap

Organization Active NPI

PDX ENT and Audiology Medical Group PC

  • Otolaryngology Physician
  • Portland, OR
National Provider Identifier
1578923751
Registry record updated Jul 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
Legal business name
PDX ENT AND AUDIOLOGY MEDICAL GROUP PC
Practice address
2222 NW Lovejoy St
607
Portland, OR 97210-3033
Phone
(503) 222-3638
Fax
(503) 223-5139
NPI assigned
Mar 1, 2016
Last updated
Jul 9, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2024

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

Authorized official

Name
Maxwell C Furr, MDNPI 1811195787
Title
President
Phone
(503) 222-3638

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
Otolaryngology Physician 207Y00000X Primary

Addresses

Primary practice location

2222 NW Lovejoy St
607
Portland, OR 97210-3033

Mailing address

2222 NW Lovejoy St
607
Portland, OR 97210-3033
Phone (503) 222-3638

Other practice location 1

17895 NW Evergreen Pkwy Ste 130
Beaverton, OR 97006-7402
Phone (503) 222-3638

Other identifiers 1

IdentifierTypeStateIssuer
500647076MedicaidOR

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160422001012 OR Part B Supplier - Clinic/Group Practice 8820397086 Receives reassigned benefits from 9 practitioners
Practice locations: Portland, OR; Beaverton, OR

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 10

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": "1456790400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720483200000",
    "number": "1578923751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2222 NW LOVEJOY ST",
            "address_2": "607",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972103033",
            "telephone_number": "503-222-3638",
            "fax_number": "503-223-5139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2222 NW LOVEJOY ST",
            "address_2": "607",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972103033",
            "telephone_number": "503-222-3638",
            "fax_number": "503-223-5139"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17895 NW Evergreen Pkwy Ste 130",
            "address_purpose": "LOCATION",
            "city": "Beaverton",
            "state": "OR",
            "postal_code": "970067402",
            "country_code": "US",
            "telephone_number": "503-222-3638",
            "fax_number": "503-223-5139",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PDX ENT AND AUDIOLOGY MEDICAL GROUP PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-01",
        "last_updated": "2024-07-09",
        "certification_date": "2024-02-05",
        "status": "A",
        "authorized_official_last_name": "FURR",
        "authorized_official_first_name": "MAXWELL",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "503-222-3638",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500647076",
            "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 Jul 9, 2024; 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.