Active NPI
Gregory S Carroll, MD
- General Practice Physician
- Tigard, OR
National Provider Identifier
1588688014
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- MD26081
- Practice address
- 10250 SW Greenburg Rd
4 Lincoln Center, Suite 125
Tigard, OR 97223-5470 - Phone
- (503) 719-6783
- Fax
- (971) 327-6734
- NPI assigned
- Jul 27, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | MD26081 | OR | |
| General Practice Physician | 208D00000X | MD26081 | OR | Primary |
Addresses
Primary practice location
10250 SW Greenburg Rd
4 Lincoln Center, Suite 125
Tigard, OR 97223-5470
Mailing address
10250 SW Greenburg Rd
4 Lincoln Center, Suite 125
Tigard, OR 97223-5470
Phone (503) 719-6783
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 005705 | Medicaid | OR |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD26081 | OR | MD | Emergency Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Clinnexus Inc. | Current | Accepting new patients | |
| Integrated Joint Specialists LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Case Manager/Care Coordinator
- Los Angeles, CA
- NPI 1245017821
-
- Clinic/Center
- Tigard, OR
- NPI 1336704071
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153958400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1295568000000",
"number": "1588688014",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10250 SW GREENBURG RD",
"address_2": "4 LINCOLN CENTER, SUITE 125",
"city": "TIGARD",
"state": "OR",
"postal_code": "972235470",
"telephone_number": "503-719-6783",
"fax_number": "971-327-6734"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10250 SW GREENBURG RD",
"address_2": "4 LINCOLN CENTER, SUITE 125",
"city": "TIGARD",
"state": "OR",
"postal_code": "972235470",
"telephone_number": "503-719-6783",
"fax_number": "971-327-6734"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARROLL",
"first_name": "GREGORY",
"middle_name": "S",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-27",
"last_updated": "2011-01-21",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "OR",
"license": "MD26081",
"primary": false
},
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "OR",
"license": "MD26081",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "005705",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tigard, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.