Individual provider Active NPI

Gunjeet K Samagh, MD

  • Family Medicine Physician
  • Portland, OR
National Provider Identifier
1700830981
Registry record updated Mar 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD26154 Issued in OR
Practice address
15640 NW Laidlaw Rd
Suite 102
Portland, OR 97229-3828
Phone
(503) 764-0100
NPI assigned
May 20, 2006
Last updated
Mar 24, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD26154 OR Primary

Addresses

Primary practice location

15640 NW Laidlaw Rd
Suite 102
Portland, OR 97229-3828

Mailing address

PO Box 3158
Portland, OR 97208-3158
Phone (503) 215-6494

Other identifiers 3

IdentifierTypeStateIssuer
273836MedicaidOR
P00774477OtherORRR MEDICARE
276726OtherORWA L&I

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address gsamagh91670@oc.providencedirect.org

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20060109000925 OR Practitioner - Family Practice 4183692908 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

15640 NW Laidlaw Rd
Suite 102
Portland, OR 97229-3828
Phone (503) 764-0100

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD26154ORMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services Oregon CurrentSince Feb 1, 2021 Accepting new patients
Providence Health & Services - Oregon CurrentSince Feb 1, 2021 Accepting new patients
Providence Health & Services Oregon Current Accepting new patients
Providence Health & Services - Oregon Family Medicine Past Accepting new patients

Locations

200 S Hazel Dell Way
Canby, OR 97013
Phone (203) 263-9500

1003 N Providence Dr
Ste 325
Newberg, OR 97132
Phone (503) 216-1661

1321 NE 99th Ave
Ste 100
Portland, OR 97220
Phone (503) 215-4050

10330 SE 32nd Ave
Ste 205
Portland, OR 97222
Phone (503) 513-8950

15640 NW Laidlaw Rd
Ste 102
Portland, OR 97229
Phone (503) 764-0100

1321 NE 99th Ave
Ste 200
Portland, OR 97220
Phone (503) 215-4250

5050 NE Hoyt St
Ste 240
Portland, OR 97213
Phone (503) 215-6480

12442 SW Scholls Ferry Rd
Ste 100
Tigard, OR 97223
Phone (503) 215-9900

Interoperability endpoints

  • Direct secure messaging: gsamagh91670@oc.providencedirect.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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1148083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616544000000",
    "number": "1700830981",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3158",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083158",
            "telephone_number": "503-215-6494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15640 NW LAIDLAW RD",
            "address_2": "SUITE 102",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972293828",
            "telephone_number": "503-764-0100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMAGH",
        "first_name": "GUNJEET",
        "middle_name": "K",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-20",
        "last_updated": "2021-03-24",
        "certification_date": "2021-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "MD26154",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "273836",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00774477",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WA L&I",
            "identifier": "276726",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gsamagh91670@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "15640 NW Laidlaw Rd",
            "address_2": "SUITE 102",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972293828",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.