Fanno Creek Clinic LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

2802 Issued in OR

Legal business name

FANNO CREEK CLINIC LLC

Practice address

2400 SW Vermont St
Portland, OR 97219-1940

Phone

(503) 452-0915

Fax

(503) 768-9232

NPI assigned

Jul 29, 2005

Last updated

Oct 16, 2007By 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

Larry M Reed

Title

Clinic Manager

Phone

(503) 452-0915

Specialties & licenses 1

Addresses

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

Interoperability endpoints

• Direct secure messaging: ckuttner@direct.fannocreek.com
• Direct secure messaging: mlevitte@direct.fannocreek.com

Practitioners 54

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.

• Luciana Arcas, DNP, FNP

  • Family Nurse Practitioner
  • Portland, OR
  • NPI 1902237613
  Medicare reassignment Care Compare group NPD
• Kathrine Elaine Avison, MD

  • Internal Medicine Physician
  • Portland, OR
  • NPI 1124126636
  Medicare reassignment Care Compare group NPD
• Leesa M Azar, MD

  • Internal Medicine Physician
  • Portland, OR
  • NPI 1629012315
  Medicare reassignment Care Compare group NPD
• Jessica D Benedict, WHCNP

  • Women's Health Nurse Practitioner
  • Hillsboro, OR
  • NPI 1740542919
  Medicare reassignment Care Compare group NPD
• Charles Joseph Bentz, MD

  • Internal Medicine Physician
  • Portland, OR
  • NPI 1518995851
  Medicare reassignment Care Compare group NPD
• Iris Briand, RDN

  • Registered Dietitian
  • Portland, OR
  • NPI 1871017723
  Medicare reassignment Care Compare group NPD
• Meei Y Choong, MD

  • Internal Medicine Physician
  • Portland, OR
  • NPI 1386644896
  Medicare reassignment Care Compare group NPD
• Gregg O Coodley, MD

  • Internal Medicine Physician
  • Portland, OR
  • NPI 1871593491
  Medicare reassignment Care Compare group NPD
• Glen Martin Cunningham, FNP

  • Family Nurse Practitioner
  • Portland, OR
  • NPI 1871450460
  Medicare reassignment Care Compare group NPD
• George B Demetrion, MD

  • Internal Medicine Physician
  • Portland, OR
  • NPI 1326048950
  Medicare reassignment Care Compare group NPD
• Jeffrey Ira Gerry, MDPHD

  • Physical Medicine & Rehabilitation Physician
  • Portland, OR
  • NPI 1396727400
  Medicare reassignment Care Compare group NPD
• Kenton W Gregory, MD

  • Cardiovascular Disease Physician
  • Portland, OR
  • NPI 1922080480
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1122595200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192492800000",
    "number": "1609876705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2400 SW VERMONT ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972191940",
            "telephone_number": "503-452-0915",
            "fax_number": "503-768-9232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 SW VERMONT ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972191940",
            "telephone_number": "503-452-0915",
            "fax_number": "503-768-9232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FANNO CREEK CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-29",
        "last_updated": "2007-10-16",
        "status": "A",
        "authorized_official_last_name": "REED",
        "authorized_official_first_name": "LARRY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CLINIC MANAGER",
        "authorized_official_telephone_number": "503-452-0915"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "2802",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chandler Lori Fanning
• Deborah Fanning, CPNP
• Jeanette Marie Fanning, QMHA
• Kimberly Fanning
• Sydney Hanna Fanning, PMHNP
• Erin Fanshier, MSW
• Edlawet G Fanta
• Hawi Fantaye, RN, BSN
• Tigist Y Fantaye
• Far East Chiropractic

• Internal Medicine Physician in Portland, OR
• Providers in Portland, OR by specialty
• Internal Medicine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2007; 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.