Individual provider Active NPI

Rosa Jaime Carbonell, MD

  • Student in an Organized Health Care Education/Training Program
  • Portland, OR
National Provider Identifier
1689178766
Registry record updated Nov 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
3181 SW Sam Jackson Park Rd # L-579
Portland, OR 97239-3098
Phone
(503) 494-8211
NPI assigned
Mar 22, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician 207VF0040X MD211258 OR
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician 207VF0040X MD70000455 WA
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

3181 SW Sam Jackson Park Rd # L-579
Portland, OR 97239-3098

Mailing address

3181 SW Sam Jackson Park Rd # L-579
Portland, OR 97239-3098
Phone (503) 494-8211

Other practice location 1

2222 NW Lovejoy St Ste 304
Portland, OR 97210-5100
Phone (503) 413-5787

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, WA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20251120002835 OR Practitioner - Obstetrics/Gynecology 0244581312 Reassigns benefits to 1 organization
I20251120003262 WA Practitioner - Obstetrics/Gynecology 0244581312 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Legacy Salmon Creek HospitalGroup PAC ID 0446295711, 309 clinicians
Legacy Clinics LLCGroup PAC ID 0244144004, 714 clinicians

Practice addresses (Care Compare)

2121 NE 139TH St
Suite 430
Vancouver, WA 98686-2316
Phone (360) 487-1414

2222 NW Lovejoy St
Suite 304
Portland, OR 97210-5100
Phone (503) 413-5787

Hospital & facility affiliations

  • Legacy Salmon Creek Medical Center Hospital, Vancouver, WA, CCN 500150
  • Legacy Good Samaritan Medical Center Hospital, Portland, OR, CCN 380017

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of the uterus1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD211258ORMDFemale Pelvic Medicine and Reconstructive Surgery (Obstetrics & Gynecology) Physician
MD70000455WAMDFemale Pelvic Medicine and Reconstructive Surgery (Obstetrics & Gynecology) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Legacy Clinics LLC CurrentSince Sep 8, 2025 Accepting new patients
Legacy Clinics LLC CurrentSince Sep 8, 2025 Accepting new patients
Legacy Salmon Creek Hospital CurrentSince Sep 8, 2025 Accepting new patients
Legacy Salmon Creek Hospital CurrentSince Sep 8, 2025 Accepting new patients

Locations

2222 NW Lovejoy St
Ste 304
Portland, OR 97210
Phone (503) 274-4994

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

19875 SW 65th Ave
Ste 250
Tualatin, OR 97062
Phone (503) 413-5525

2211 NE 139th St
Vancouver, WA 98686
Phone (360) 397-1985

2121 NE 139th St
Ste 430
Vancouver, WA 98686
Phone (360) 487-1414

Interoperability endpoints

  • Direct secure messaging: rcarbonell1593804@direct.lhs.org

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 4

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": "1521676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762473600000",
    "number": "1689178766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3181 SW SAM JACKSON PARK RD # L-579",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972393098",
            "telephone_number": "503-494-8211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3181 SW SAM JACKSON PARK RD # L-579",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972393098",
            "telephone_number": "503-494-8211"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2222 NW Lovejoy St Ste 304",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972105100",
            "country_code": "US",
            "telephone_number": "503-413-5787",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CARBONELL",
        "first_name": "ROSA",
        "middle_name": "JAIME",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-22",
        "last_updated": "2025-11-07",
        "certification_date": "2025-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207VF0040X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery",
            "state": "OR",
            "license": "MD211258",
            "primary": false
        },
        {
            "code": "207VF0040X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery",
            "state": "WA",
            "license": "MD70000455",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.