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Individual provider Active NPI

Breanna Summers Thompson, DO

  • Family Medicine Physician
  • Sherwood, OR
National Provider Identifier
1710129473
Registry record updated Jan 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
DO202589 Issued in OR
Practice address
16770 SW Edy Rd Ste 102
Sherwood, OR 97140-9679
Phone
(503) 216-9600
NPI assigned
Mar 27, 2009
Last updated
Jan 2, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 2, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X DO202589 OR Primary
Pediatrics Physician 208000000X DR.0049522 CO
Pediatrics Physician 208000000X DO202589 OR

Addresses

Primary practice location

16770 SW Edy Rd Ste 102
Sherwood, OR 97140-9679

Mailing address

PO Box 3158
Portland, OR 97208-3158

Other identifiers 1

IdentifierTypeStateIssuer
71333240MedicaidCO

Other names 1

  • Breanna Marie Summers Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210803003618 OR Practitioner - Family Practice 5294983771 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Des Moines University of Osteopathic Medicine and Health Sciences, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

16770 SW Edy Rd
Suite 102
Sherwood, OR 97140-9679
Phone (503) 216-9600

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
DO202589ORMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services Oregon Current Accepting new patients
Providence Health & Services - Oregon CurrentSince Jan 13, 2025 Accepting new patients
Providence Health & Services Oregon CurrentSince Jan 13, 2025 Accepting new patients
Willamette Valley Clinics LLC Family Medicine CurrentSince Jul 1, 2021 Accepting new patients
Providence Health & Services - Oregon Family Medicine Past Accepting new patients

Locations

254 NE Norton Ln
McMinnville, OR 97128
Phone (503) 472-6161

2700 SE Stratus Ave
Unit 302
McMinnville, OR 97128
Phone (503) 474-2565

2700 SE Stratus Ave
Unit 402
McMinnville, OR 97128
Phone (503) 434-1110

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

16770 SW Edy Rd
Ste 102
Sherwood, OR 97140
Phone (503) 215-9600

330 Seven Springs Way
Brentwood, TN 37027
Phone (615) 920-7780

Organizations & group practices 5

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 6

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": "1238112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735776000000",
    "number": "1710129473",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16770 SW EDY RD STE 102",
            "city": "SHERWOOD",
            "state": "OR",
            "postal_code": "971409679",
            "telephone_number": "503-216-9600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THOMPSON",
        "first_name": "BREANNA",
        "middle_name": "SUMMERS",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-03-27",
        "last_updated": "2025-01-02",
        "certification_date": "2025-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "DO202589",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CO",
            "license": "DR.0049522",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OR",
            "license": "DO202589",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "71333240",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BREANNA",
            "last_name": "SUMMERS",
            "middle_name": "MARIE",
            "credential": "DO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Sherwood, OR

Sources for this page

Verify at the official NPI Registry.