NPIMap

Organization Active NPI

Skin Cancer Surgery Center

  • Preferred Provider Organization
  • Tualatin, OR
National Provider Identifier
1699943126
Registry record updated Jan 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Preferred Provider OrganizationTaxonomy code 305R00000X
License
23409 Issued in OR
Legal business name
SKIN CANCER SURGERY CENTER
Doing business as
Skin Cancer Surgery Center
Practice address
6370 SW Borland Rd.
Suite 200
Tualatin, OR 97062
Phone
(503) 691-1122
Fax
(503) 691-1144
NPI assigned
Feb 19, 2008
Last updated
Jan 11, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2024

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

Authorized official

Name
Andrea Pena
Title
Clinic Manager
Phone
(503) 691-1122

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Preferred Provider Organization 305R00000X 23409 OR Primary

Addresses

Primary practice location

6370 SW Borland Rd.
Suite 200
Tualatin, OR 97062

Mailing address

6370 SW Borland Rd.
Suite 200
Tualatin, OR 97062
Phone (503) 691-1122

Other identifiers 1

IdentifierTypeStateIssuer
287107MedicaidOR

Other names 1

  • Skin Cancer Surgery Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050120000592 OR Part B Supplier - Clinic/Group Practice 1355390980 Receives reassigned benefits from 4 practitioners
Practice locations: Tualatin, OR

National Provider Directory

National Provider Directory

Locations

6370 SW Borland Rd
Ste 200
Tualatin, OR 97062
Phone (503) 691-1122

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1203379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704931200000",
    "number": "1699943126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6370 SW BORLAND RD.",
            "address_2": "SUITE 200",
            "city": "TUALATIN",
            "state": "OR",
            "postal_code": "97062",
            "telephone_number": "503-691-1122",
            "fax_number": "503-691-1144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6370 SW BORLAND RD.",
            "address_2": "SUITE 200",
            "city": "TUALATIN",
            "state": "OR",
            "postal_code": "97062",
            "telephone_number": "503-691-1122",
            "fax_number": "503-691-1144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SKIN CANCER SURGERY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-19",
        "last_updated": "2024-01-11",
        "certification_date": "2023-04-11",
        "status": "A",
        "authorized_official_last_name": "PENA",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_title_or_position": "CLINIC MANAGER",
        "authorized_official_telephone_number": "503-691-1122"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "OR",
            "license": "23409",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "287107",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Skin Cancer Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Skin Cancer Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tualatin, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.