Individual provider Active NPI

Emily Kathryn Goerke, CRNA

  • Certified Registered Nurse Anesthetist
  • Portland, OR
National Provider Identifier
1639476153
Registry record updated Feb 28, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
201160047CRNA Issued in OR
Practice address
6400 SE Lake Road, Suite 130
Anesthesia Associates Northwest
Portland, OR 97222
Phone
(503) 594-1774
Fax
(503) 594-1775
NPI assigned
Feb 18, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X R 184004-9 MN
Certified Registered Nurse Anesthetist 367500000X 201160047CRNA OR Primary

Addresses

Primary practice location

6400 SE Lake Road, Suite 130
Anesthesia Associates Northwest
Portland, OR 97222

Mailing address

5741 SW Miles St
Portland, OR 97219
Phone (507) 284-2511

Other identifiers 2

IdentifierTypeStateIssuer
ENROLLEDMedicaidMN
ENROLLEDMedicaidIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120130000049 OR Practitioner - Certified Registered Nurse Anesthetist (Crna) 8921283904 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Salem HealthGroup PAC ID 8628986668, 470 clinicians

Practice addresses (Care Compare)

890 Oak St SE
Suite 4000
Salem, OR 97301-3905
Phone (503) 814-4048

Hospital & facility affiliations

  • Salem Hospital Hospital, Salem, OR, CCN 380051

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
R 184004-9MNMDCertified Registered Nurse Anesthetist
201160047CRNAORMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Salem Health Current Accepting new patients
Salem Health CurrentSince Dec 1, 2022 Accepting new patients
Salem Health CurrentSince Dec 1, 2022 Accepting new patients
Portland Anesthesia Specialists LLC Past Accepting new patients

Locations

665 Winter St SE
Salem, OR 97301
Phone (503) 370-5634

890 Oak St SE
Ste 4000
Salem, OR 97301
Phone (503) 814-4048

Organizations & group practices 4

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 1

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": "1297987200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1393545600000",
    "number": "1639476153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5741 SW MILES ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97219",
            "telephone_number": "507-284-2511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6400 SE LAKE ROAD, SUITE 130",
            "address_2": "ANESTHESIA ASSOCIATES NORTHWEST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97222",
            "telephone_number": "503-594-1774",
            "fax_number": "503-594-1775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOERKE",
        "first_name": "EMILY",
        "middle_name": "KATHRYN",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-02-18",
        "last_updated": "2014-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MN",
            "license": "R 184004-9",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "OR",
            "license": "201160047CRNA",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ENROLLED",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ENROLLED",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2014; 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.