NPIMap

Individual provider Active NPI

Emoniel Isakharov

  • Internal Medicine Physician
  • Tualatin, OR
National Provider Identifier
1649777863
Registry record updated Jul 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD204965 Issued in OR
Practice address
19875 SW 65TH Ave Ste 100
Tualatin, OR 97062-8353
Phone
(503) 692-7785
NPI assigned
Apr 13, 2018
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 27, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X MD204965 OR Primary

Addresses

Primary practice location

19875 SW 65TH Ave Ste 100
Tualatin, OR 97062-8353

Mailing address

PO Box 6689
Portland, OR 97228-6689
Phone (503) 413-3900

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
I20210706002148 OR Practitioner - Internal Medicine 5294088241 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Washington School of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Legacy Meridian Park HospitalGroup PAC ID 5092609842, 113 clinicians
Legacy Emanuel Hospital and Health CenterGroup PAC ID 4587573639, 235 clinicians

Practice addresses (Care Compare)

19875 SW 65TH Ave
Tualatin, OR 97062-8353
Phone (503) 692-7785

2800 N Vancouver Ave
Suite 230
Portland, OR 97227-1668
Phone (503) 413-4340

2801 N Gantenbein Ave
Portland, OR 97227-1623
Phone (503) 413-2042

Hospital & facility affiliations

  • Centerwell Home Health Home health agency, Vancouver, WA, CCN 507081
  • Providence Home Health Home health agency, Portland, OR, CCN 387048
  • Amedisys Home Health Care Home health agency, Salem, OR, CCN 387136
  • Ageright Care at Home Home health agency, Milwaukie, OR, CCN 387151
  • Legacy Meridian Park Medical Center Hospital, Tualatin, OR, CCN 380089
  • Legacy Emanuel Medical Center Hospital, Portland, OR, CCN 380007
  • Ohsu Hospital and Clinics Hospital, Portland, OR, CCN 380009
  • Legacy Silverton Medical Center Hospital, Silverton, OR, CCN 380029

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions22
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD204965ORMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Legacy Emanuel Hospital & Health Center Current Accepting new patients
Legacy Good Samaritan Hospital and Medical Center CurrentSince May 4, 2022 Accepting new patients
Legacy Emanuel Hospital & Health Center CurrentSince May 4, 2022 Accepting new patients
Legacy Meridian Park Hospital CurrentSince Jul 1, 2021 Accepting new patients
Legacy Emanuel Hospital & Health Center CurrentSince May 4, 2022 Accepting new patients
Legacy Good Samaritan Hospital and Medical Center CurrentSince May 4, 2022 Accepting new patients
Legacy Good Samaritan Hospital and Medical Center Current Accepting new patients
Legacy Meridian Park Hospital PastSince Aug 1, 2021 Accepting new patients
Legacy Meridian Park Pediatric Rehab PastSince Aug 1, 2021 Accepting new patients

Locations

1919 NW Lovejoy St
Portland, OR 97209
Phone (503) 415-5600

1200 NW 23rd Ave
Portland, OR 97210
Phone (503) 413-7074

2801 N Gantenbein Ave
Portland, OR 97227
Phone (503) 413-2200

19875 SW 65th Ave
Ste 100
Tualatin, OR 97062
Phone (503) 692-7785

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

19875 SW 65th Ave
Tualatin, OR 97062
Phone (503) 692-2657

Interoperability endpoints

  • Direct secure messaging: eisakharov622484@direct.lhs.org

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 and National Provider Directory roles.

Hospital & facility affiliations 10

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": "1523577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627344000000",
    "number": "1649777863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6689",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972286689",
            "telephone_number": "503-413-3900",
            "fax_number": "503-413-3710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19875 SW 65TH AVE STE 100",
            "city": "TUALATIN",
            "state": "OR",
            "postal_code": "970628353",
            "telephone_number": "503-692-7785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ISAKHAROV",
        "first_name": "EMONIEL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-04-13",
        "last_updated": "2021-07-27",
        "certification_date": "2021-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "MD204965",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tualatin, OR

Sources for this page

Verify at the official NPI Registry.