NPIMap

Organization Active NPI

Oregon Health & Science University

  • Oral and Maxillofacial Pathology Dentistry
  • Portland, OR
National Provider Identifier
1609837574
Registry record updated Aug 4, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Pathology DentistryTaxonomy code 1223P0106X
Legal business name
OREGON HEALTH & SCIENCE UNIVERSITY
Practice address
2730 SW Moody Ave
SD-Path
Portland, OR 97201-5042
Phone
(503) 494-8904
NPI assigned
Mar 30, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2014

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

Authorized official

Name
Jeffrey Stewart, DDS
Title
President
Phone
(503) 494-8904

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Pathology DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0106X Primary
Clinical Medical Laboratory 291U00000X

Addresses

Primary practice location

2730 SW Moody Ave
SD-Path
Portland, OR 97201-5042

Mailing address

PO Box 10076
Van Nuys, CA 91410-0076
Phone (805) 578-8300

Other identifiers 1

IdentifierTypeStateIssuer
182769MedicaidCA

Other names 1

  • DIAGNOSTIC LAB OHSU DENTISTRY SCH Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040415000871 OR Part B Supplier - Independent Clinical Laboratory 7618962176 Practice locations: Portland, OR

National Provider Directory

National Provider Directory

Locations

611 SW Campus Dr
#515
Portland, OR 97239
Phone (503) 494-8904

611 SW Campus Dr
Portland, OR 97239
Phone (503) 494-4316

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1143676800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1407110400000",
    "number": "1609837574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10076",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914100076",
            "telephone_number": "805-578-8300",
            "fax_number": "805-578-8950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2730 SW MOODY AVE",
            "address_2": "SD-PATH",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972015042",
            "telephone_number": "503-494-8904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OREGON HEALTH & SCIENCE UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-30",
        "last_updated": "2014-08-04",
        "status": "A",
        "authorized_official_last_name": "STEWART",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "503-494-8904",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0106X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Pathology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "182769",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DIAGNOSTIC LAB OHSU DENTISTRY SCH",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Aug 4, 2014; 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.