NPIMap

Organization Active NPI

Oregon Department of Corrections

  • Prison Health Clinic/Center
  • Portland, OR
National Provider Identifier
1609690908
Registry record updated Nov 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prison Health Clinic/CenterTaxonomy code 261QP2400X
Legal business name
OREGON DEPARTMENT OF CORRECTIONS
Practice address
9111 NE Sunderland Ave
Portland, OR 97211
Phone
(503) 428-9443
NPI assigned
Nov 13, 2024
Organization subpart
Yes
Parent organization
OREGON DEPARTMENT OF CORRECTIONSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 13, 2024

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

Authorized official

Name
Rob Cory Nutt
Title
Chief Pharmacy Officer
Phone
(503) 986-6967

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Prison Health Clinic/Center 261QP2400X Primary

Addresses

Primary practice location

9111 NE Sunderland Ave
Portland, OR 97211

Mailing address

2757 22ND St SE
Salem, OR 97302

Other names 1

  • Columbia River Correctional Institution Other name

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
38D2198728Columbia River Correctional Institution9111 NE Sunderland Avenue, Portland, OR 97211Certificate of waiverNov 2, 2026

National Provider Directory

National Provider Directory
Tax ID family
Salem Correctional Pharmacy13 organizations share this tax ID, including this one
Part of
Salem Correctional Pharmacy

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2757 22nd St SE
Salem, OR 97302
Phone (503) 378-5569

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1731456000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731456000000",
    "number": "1609690908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2757 22ND ST SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "97302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9111 NE SUNDERLAND AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97211",
            "telephone_number": "503-428-9443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OREGON DEPARTMENT OF CORRECTIONS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OREGON DEPARTMENT OF CORRECTIONS",
        "enumeration_date": "2024-11-13",
        "last_updated": "2024-11-13",
        "status": "A",
        "authorized_official_last_name": "NUTT",
        "authorized_official_first_name": "ROB",
        "authorized_official_middle_name": "CORY",
        "authorized_official_title_or_position": "CHIEF PHARMACY OFFICER",
        "authorized_official_telephone_number": "503-986-6967"
    },
    "taxonomies": [
        {
            "code": "261QP2400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Prison Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Columbia River Correctional Institution",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Nov 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.