Providence Health & Services - Oregon

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

PROVIDENCE HEALTH & SERVICES - OREGON

Doing business as

Providence Medical Group
Providence Medical Group Milwaukie Family Medicine

Practice address

10330 SE 32ND Ave
Suite 205
Milwaukie, OR 97222-6594

Phone

(503) 513-8950

Fax

(503) 513-8951

NPI assigned

Sep 13, 2006

Last updated

Jun 30, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Donald W Anderson Jr.

Title

Assistant Secretary Enrollment

Phone

(425) 358-9786

Specialties & licenses 4

Addresses

Other identifiers 1

Other names 2

• PROVIDENCE MEDICAL GROUP Doing business as
• PROVIDENCE MEDICAL GROUP MILWAUKIE FAMILY MEDICINE Doing business as

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jessica Frances Baca, PA-C

  • Physician Assistant
  • Salem, OR
  • NPI 1033699731
  NPD
• Andrew David Bodmer, PA-C

  • Physician Assistant
  • Tigard, OR
  • NPI 1083860548
  NPD
• Lawanda Lynn Dimmler Sr., PA-C

  • Physician Assistant
  • Portland, OR
  • NPI 1528031812
  NPD
• Jennifer Higham, PA-C

  • Physician Assistant
  • Newberg, OR
  • NPI 1144876947
  NPD
• Christina Marie O'Guinn, FNP

  • Family Nurse Practitioner
  • Portland, OR
  • NPI 1265048151
  NPD
• Hachau C Phan, AGACNP-BC

  • Gerontology Nurse Practitioner
  • Portland, OR
  • NPI 1811477557
  NPD
• Sean Simons, PA-C

  • Physician Assistant
  • Milwaukie, OR
  • NPI 1083003529
  NPD
• Chinmay Shivaram Paranjape, MD

  • Pediatric Orthopaedic Surgery Physician
  • San Diego, CA
  • NPI 1932633799
  NPD

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

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1751241600000",
    "number": "1699870873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31001 - 4180",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911104180",
            "telephone_number": "503-215-6494",
            "fax_number": "503-215-6644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10330 SE 32ND AVE",
            "address_2": "SUITE 205",
            "city": "MILWAUKIE",
            "state": "OR",
            "postal_code": "972226594",
            "telephone_number": "503-513-8950",
            "fax_number": "503-513-8951"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH & SERVICES - OREGON",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-13",
        "last_updated": "2025-06-30",
        "certification_date": "2025-06-30",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY ENROLLMENT",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "022861",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PROVIDENCE MEDICAL GROUP",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PROVIDENCE MEDICAL GROUP MILWAUKIE FAMILY MEDICINE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PROVIDENCE MEDICAL GROUP MILWAUKIE FAMILY MEDICINE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jessica M Prior, PHARMD
• Maria V Prokhorova, MD
• Protech Automotive Inc
• Providence Health & Services - Oregon (Providence Medical Group)
• Providence Health & Services - Oregon (Providence Medical Group)
• Providence Health & Services - Oregon (Providence Hospitalists Southeast)
• Providence Health & Services - Oregon (Providence Medical Group)
• Providence Health & Services - Oregon (Providence Medical Group)
• Providence Health & Services Oregon (Providence Milwaukie Hospital)
• Providence Health & Services Oregon (Providence Milwaukie Hospital)

• Family Medicine Physician in Milwaukie, OR
• Providers in Milwaukie, 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 Jun 30, 2025; 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.