Matthew'S Family Primary Care, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

MATTHEW'S FAMILY PRIMARY CARE, LLC

Practice address

18514 SE Wilmot St Unit B
Milwaukie, OR 97267-6426

Phone

(678) 793-8808

NPI assigned

Oct 23, 2024

Organization subpart

No

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

Authorized official

Name

Dr. Berhanu Ejigu Kededa, FNP, AGACNP, DNPNPI 1184994105

Title

Owner, Director

Phone

(678) 793-8808

Specialties & licenses 2

Addresses

Other names 1

• Matthew's Family Primary Care, LLC Doing business as

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Practitioners 1

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

• Berhanu Ejigu Kededa, NP-C

  • Family Nurse Practitioner
  • Tucker, GA
  • NPI 1184994105

  Multi-Specialty, OR

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1729641600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732579200000",
    "number": "1629899448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18514 SE WILMOT ST UNIT B",
            "city": "MILWAUKIE",
            "state": "OR",
            "postal_code": "972676426",
            "telephone_number": "678-793-8808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18514 SE WILMOT ST UNIT B",
            "city": "MILWAUKIE",
            "state": "OR",
            "postal_code": "972676426",
            "telephone_number": "678-793-8808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MATTHEW'S FAMILY PRIMARY CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-23",
        "last_updated": "2024-11-26",
        "certification_date": "2024-11-26",
        "status": "A",
        "authorized_official_last_name": "KEDEDA",
        "authorized_official_first_name": "BERHANU",
        "authorized_official_middle_name": "EJIGU",
        "authorized_official_title_or_position": "OWNER, DIRECTOR",
        "authorized_official_telephone_number": "678-793-8808",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "FNP, AGACNP, DNP"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Matthew's Family Primary Care, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Markus Mastrud, RN
• Cathy I Matheson, ORTL
• Beth M Matile, DMD
• David D Matile, DMD
• Matthew T a Sugalski MD PC
• Eric Matzelle, D.M.D.
• Wendy Maybury
• Dennis O. Mayer, MD
• Ian Thomas McAnnis-Entenman
• John McCabe

• Family Medicine Physician in Milwaukie, OR
• Providers in Milwaukie, OR by specialty
• Family Medicine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2024; 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.