PNW Management Group

Primary specialty

Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X

Legal business name

PNW MANAGEMENT GROUP

Doing business as

Advanced Vascular Centers Portland

Practice address

6958 SW Varns St
Portland, OR 97223-8281

Phone

(503) 683-7730

Fax

(503) 914-0927

NPI assigned

Apr 13, 2020

Last updated

Jan 26, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Mary M Costantino, MDNPI 1407951171

Title

Physician Owner

Phone

(503) 683-7730

Specialties & licenses 1

Addresses

Other names 1

• Advanced Vascular Centers Portland Doing business as

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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.

• Mary Marcelle Costantino, MD

  • Vascular & Interventional Radiology Physician
  • Portland, OR
  • NPI 1407951171
  Medicare reassignment Care Compare group NPD Authorized official
• Andrew Thomas Gentile, M.D.

  • Vascular Surgery Physician
  • Happy Valley, OR
  • NPI 1396859633
  Medicare reassignment Care Compare group NPD
• Kendra L Thoren, D.O.

  • Vascular & Interventional Radiology Physician
  • Hillsboro, OR
  • NPI 1598925968
  Medicare reassignment Care Compare group NPD
• Carrie Marie Hayes, MHS PA-C

  • Surgical Physician Assistant
  • Portland, OR
  • NPI 1215333406
  Medicare reassignment
• Pamela J Phelan, PAC

  • Surgical Physician Assistant
  • Portland, OR
  • NPI 1649239278
  Medicare reassignment

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

{
    "created_epoch": "1586736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643155200000",
    "number": "1588283154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6958 SW VARNS ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972238281",
            "telephone_number": "503-683-7730",
            "fax_number": "503-914-0927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6958 SW VARNS ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972238281",
            "telephone_number": "503-683-7730",
            "fax_number": "503-914-0927"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PNW MANAGEMENT GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-13",
        "last_updated": "2022-01-26",
        "certification_date": "2022-01-26",
        "status": "A",
        "authorized_official_last_name": "COSTANTINO",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PHYSICIAN OWNER",
        "authorized_official_telephone_number": "503-683-7730",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Vascular Centers Portland",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Michael L Plunkett, DDS, MPH
• Pluspsychiatry LLC
• Pluto Mental Health LLC (Pluto Mental Health)
• Brittany Marie Plymell, DC
• Pneuma Counseling, LLC
• PNW Massage and Acupuncture LLC
• PNW Nutrition and Recovery
• PNW Psychiatric Services Professional Corporation
• PNW Spine and Joint Physicians
• PNW-ADHD Clinic

• Vascular & Interventional Radiology Physician in Portland, OR
• Providers in Portland, OR by specialty
• Vascular & Interventional Radiology Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.