NPIMap

Individual provider Active NPI

John Stephen Domreis, M.D.

  • Surgery Physician
  • Oregon City, OR
National Provider Identifier
1629168646
Registry record updated Apr 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
MD24678 Issued in OR
Practice address
1510 Division St Ste 210
Oregon City, OR 97045-1599
Phone
(503) 723-6525
NPI assigned
Oct 13, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X MD24678 OR Primary

Addresses

Primary practice location

1510 Division St Ste 210
Oregon City, OR 97045-1599

Mailing address

PO Box 3158
Portland, OR 97208-3158
Phone (503) 215-6494

Other practice location 1

9200 SE 91st Ave
320
Portland, OR 97086-6756
Phone (503) 353-3005

Other identifiers 2

IdentifierTypeStateIssuer
227359MedicaidOR
858363001OtherORREGENCE BC/BS OR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040123000176 OR Practitioner - General Surgery 9133021868 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
New York Medical College, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1510 Division St
Suite 210
Oregon City, OR 97045-1599
Phone (503) 723-6525

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy58
Hernia repair - groin (open)16
Hernia repair (minimally invasive)17
Upper gastrointestinal (GI) endoscopy for acid reflux1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD24678ORMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services Oregon CurrentSince Feb 1, 2022 Accepting new patients
Providence Health & Services Oregon Current Accepting new patients
Providence Health & Services Oregon CurrentSince Feb 1, 2022 Accepting new patients
Providence Health & Services - Oregon CurrentSince Feb 1, 2022 Accepting new patients
Providence Health & Services Oregon Current Accepting new patients
Providence Health & Services Oregon CurrentSince Feb 1, 2022 Accepting new patients
Providence Health & Services - Oregon Current Accepting new patients
Providence Health & Services - Oregon CurrentSince Feb 1, 2022 Accepting new patients
Providence Health & Services - Oregon Past Accepting new patients
Oregon Cosmetic and Reconstructive Clinic, PC PastSince Jan 1, 2006 Accepting new patients

Locations

200 S Hazel Dell Way
Ste 210
Canby, OR 97013
Phone (503) 263-9550

200 S Hazel Dell Way
Canby, OR 97013
Phone (203) 263-9500

1500 Division St
Oregon City, OR 97045
Phone (503) 646-1631

1510 Division St
Ste 210
Oregon City, OR 97045
Phone (503) 655-6313

1321 NE 99th Ave
Ste 200
Portland, OR 97220
Phone (503) 215-4250

5050 NE Hoyt St
Ste 240
Portland, OR 97213
Phone (503) 215-6480

10150 SE 32nd Ave
Portland, OR 97222
Phone (503) 215-4202

Organizations & group practices 10

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.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650931200000",
    "number": "1629168646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3158",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083158",
            "telephone_number": "503-215-6494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1510 DIVISION ST STE 210",
            "city": "OREGON CITY",
            "state": "OR",
            "postal_code": "970451599",
            "telephone_number": "503-723-6525"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9200 SE 91st Ave",
            "address_2": "320",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "970866756",
            "country_code": "US",
            "telephone_number": "503-353-3005",
            "fax_number": "503-546-3201",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DOMREIS",
        "first_name": "JOHN",
        "middle_name": "STEPHEN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-13",
        "last_updated": "2022-04-26",
        "certification_date": "2022-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "OR",
            "license": "MD24678",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "227359",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BC/BS OR",
            "identifier": "858363001",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oregon City, OR

Sources for this page

Verify at the official NPI Registry.