Lyle James Fagnan, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD10673 Issued in OR

Practice address

4411 SW Vermont St
Portland, OR 97219-1020

Phone

(503) 494-9992

NPI assigned

Jul 31, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Oregon Health & Science University

  • Rural Health Clinic/Center
  • Scappoose, OR
  • NPI 1417969304
  Medicare reassignment NPD
• Oregon Health & Science University

  • Community/Retail Pharmacy
  • Portland, OR
  • NPI 1457129678
  NPD
• Oregon Health & Science University

  • Federally Qualified Health Center (FQHC)
  • Portland, OR
  • NPI 1477675148
  NPD

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

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184284800000",
    "number": "1669487161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3181 SW SAM JACKSON PARK RD",
            "address_2": "L222",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972393011",
            "telephone_number": "503-494-1582",
            "fax_number": "503-494-1513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4411 SW VERMONT ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972191020",
            "telephone_number": "503-494-9992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAGNAN",
        "first_name": "LYLE",
        "middle_name": "JAMES",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-31",
        "last_updated": "2007-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "MD10673",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "235119",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Collaine Brooke Faddis, LMT
• Emily Fagan, LPC
• Paul Fagan, MA, LPC
• Sue Fagan, FNP
• Goldis Faghihi, ND, DC
• Diana Marie Fahey, CADC-R
• Sara Fahey, C.N.M., ARNP
• Thomas R Fahrbach, MD
• Deanne Fahy, LMFT, LPC
• Charles Sevidzem Fai

• Family Medicine Physician in Portland, OR
• Providers in Portland, 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 Jul 13, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.