Individual provider Active NPI

Robin E Shea, ANP

  • Adult Health Nurse Practitioner
  • Portland, OR
National Provider Identifier
1639258346
Registry record updated Oct 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
084054428N3 ANP-PP Issued in OR
Practice address
1030 NE Couch St
Portland, OR 97232-3067
Phone
(503) 239-8400
Fax
(503) 239-8406
NPI assigned
Nov 3, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 084054428N3 ANP-PP OR Primary

Addresses

Primary practice location

1030 NE Couch St
Portland, OR 97232-3067

Mailing address

1027 E Burnside St
Portland, OR 97214-1328
Phone (503) 239-8400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20061117000491 OR Practitioner - Nurse Practitioner 3274531629 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
084054428N3 ANP-PPORMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Coda, Inc. CurrentSince Nov 6, 2022 Accepting new patients
Coda, Inc. CurrentSince Nov 6, 2022 Accepting new patients
University Professional Services PastSince Nov 6, 2022 Accepting new patients
University Professional Services PastSince Nov 6, 2022 Accepting new patients

Locations

1027 E Burnside St
Portland, OR 97214

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667174400000",
    "number": "1639258346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1027 E BURNSIDE ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972141328",
            "telephone_number": "503-239-8400",
            "fax_number": "503-239-8407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1030 NE COUCH ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972323067",
            "telephone_number": "503-239-8400",
            "fax_number": "503-239-8406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHEA",
        "first_name": "ROBIN",
        "middle_name": "E",
        "name_prefix": "Ms.",
        "credential": "ANP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-03",
        "last_updated": "2022-10-31",
        "certification_date": "2022-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "OR",
            "license": "084054428N3 ANP-PP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.