NPIMap

Individual provider Active NPI

Tana Marie Haynes, M.D.

  • Internal Medicine Physician
  • Tualatin, OR
National Provider Identifier
1639160369
Registry record updated Jun 25, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD24660 Issued in OR
Practice address
19260 SW 65TH Ave Ste 270
Suite B2
Tualatin, OR 97062-5705
Phone
(503) 699-0764
Fax
(503) 329-1851
NPI assigned
Nov 2, 2005
Last updated
Jun 25, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD24660 OR Primary

Addresses

Primary practice location

19260 SW 65TH Ave Ste 270
Suite B2
Tualatin, OR 97062-5705

Mailing address

PO Box 869
Tualatin, OR 97062-0869
Phone (503) 691-0169

Other identifiers 1

IdentifierTypeStateIssuer
029123MedicaidOR

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
I20040217000588 OR Practitioner - Internal Medicine 7911809082 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Oregon Health Sciences University School of Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1100 3Rd St
Tillamook, OR 97141-3402
Phone (503) 815-2280

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.62 of 100Reported as apm
Quality
77.21
Promoting interoperability
99.06
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
83.81 of 100Reported as group
Quality
71.23
Promoting interoperability
88
Improvement activities
40
Cost
81.9

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD24660ORMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northwest Medical Foundation of Tillamook CurrentSince Dec 1, 2020 Accepting new patients
Northwest Medical Foundation of Tillamook CurrentSince Dec 1, 2020 Accepting new patients
Silverton Health CurrentSince Mar 20, 2020 Accepting new patients
Silverton Health Current Accepting new patients
Silverton Health CurrentSince Mar 20, 2020 Accepting new patients
Northwest Medical Foundation of Tillamook CurrentSince Jan 1, 2026 Accepting new patients
Legacy Clinics LLC Internal Medicine CurrentSince Dec 15, 2018 Accepting new patients
Northwest Medical Foundation of Tillamook Past Accepting new patients

Locations

24800 SE Stark St
Gresham, OR 97030
Phone (503) 413-8407

1130 NW 22nd Ave
Ste 220
Portland, OR 97210
Phone (503) 413-4134

342 Fairview St
Silverton, OR 97381
Phone (503) 525-7660

347 Fairview St
Silverton, OR 97381
Phone (503) 873-5667

1000 3rd St
Tillamook, OR 97141
Phone (503) 251-6129

1000 3rd St
#M
Tillamook, OR 97141
Phone (503) 815-2260

1100 3rd St
Tillamook, OR 97141
Phone (503) 815-2116

19300 SW 65th Ave
Tualatin, OR 97062
Phone (503) 692-1212

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1130889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1372118400000",
    "number": "1639160369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 869",
            "city": "TUALATIN",
            "state": "OR",
            "postal_code": "970620869",
            "telephone_number": "503-691-0169",
            "fax_number": "503-699-9237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19260 SW 65TH AVE STE 270",
            "address_2": "SUITE B2",
            "city": "TUALATIN",
            "state": "OR",
            "postal_code": "970625705",
            "telephone_number": "503-699-0764",
            "fax_number": "503-329-1851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAYNES",
        "first_name": "TANA",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-02",
        "last_updated": "2013-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "MD24660",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "029123",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tualatin, OR

Sources for this page

Verify at the official NPI Registry.