NPIMap

Organization Active NPI

Premise Health of Oregon Medical P C

Doing business as Occupational Health Services Roncler Acres 4

  • Multi-Specialty Clinic/Center
  • Hillsboro, OR
National Provider Identifier
1700526092
Registry record updated Oct 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
PREMISE HEALTH OF OREGON MEDICAL P C
Doing business as
Occupational Health Services Roncler Acres 4
Practice address
2501 NE Century Blvd
Hillsboro, OR 97124-5506
Phone
(502) 613-6266
Fax
(503) 214-5886
NPI assigned
Apr 1, 2022
Last updated
Oct 13, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2022

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

Authorized official

Name
Jonathan LeizmanNPI 1447249677
Title
President
Phone
(216) 479-9063

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X NU Primary

Addresses

Primary practice location

2501 NE Century Blvd
Hillsboro, OR 97124-5506

Mailing address

5500 Maryland Way Ste 120
Brentwood, TN 37027-4993

Other names 1

  • Occupational Health Services Roncler Acres 4 Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
38D1094750Premise Health of Oregon Medical, PC2501 NW Century Blvd Ms Ra3-113, Hillsboro, OR 97124Certificate of waiverJan 25, 2027
38D2258653Premise Health of Oregon Medical, PC2501 NE Century Blvd, M/a Ra4-3 Delivery Station, Hillsboro, OR 97124Certificate of waiverApr 24, 2028

National Provider Directory

National Provider Directory
Tax ID family
Deschutes Juvenile Detention Center Clinic9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2501 NE Century Blvd
Hillsboro, OR 97124
Phone (502) 613-6266

Practitioners & affiliated clinicians

Practitioners 1

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": "1648771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665619200000",
    "number": "1700526092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5500 MARYLAND WAY STE 120",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370274993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2501 NE CENTURY BLVD",
            "city": "HILLSBORO",
            "state": "OR",
            "postal_code": "971245506",
            "telephone_number": "502-613-6266",
            "fax_number": "503-214-5886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMISE HEALTH OF OREGON MEDICAL P C",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-01",
        "last_updated": "2022-10-13",
        "certification_date": "2022-10-13",
        "status": "A",
        "authorized_official_last_name": "LEIZMAN",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "216-479-9063"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Occupational Health Services Roncler Acres 4",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Occupational Health Services Roncler Acres 4",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hillsboro, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.