Lake Oswego Dermatology Group, PC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

LAKE OSWEGO DERMATOLOGY GROUP, PC

Practice address

17704 Jean Way
Suite 102
Lake Oswego, OR 97035-5497

Phone

(503) 635-9221

Fax

(503) 635-5902

NPI assigned

Nov 8, 2007

Organization subpart

No

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

Authorized official

Name

Rita Shigeta II

Title

Office Manager

Phone

(503) 635-9221

Specialties & licenses 1

Addresses

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.

• Betty Si Yuan Jiang

  • Dermatology Physician
  • Lake Oswego, OR
  • NPI 1194110288
  Medicare reassignment Care Compare group NPD
• Andrew E Pitt, MD

  • Dermatology Physician
  • Lake Oswego, OR
  • NPI 1275699118
  Medicare reassignment Care Compare group NPD
• Bridget Downey Hartman, M.D.

  • Dermatology Physician
  • Thousand Oaks, CA
  • NPI 1447541511

  OR

  Medicare reassignment Care Compare group NPD
• Helen Liu, M.D.

  • Student in an Organized Health Care Education/Training Program
  • San Jose, CA
  • NPI 1801022876

  OR

  Medicare reassignment Care Compare group NPD
• Stephen W Doggett, M.D.

  • Radiation Oncology Physician
  • Newport Beach, CA
  • NPI 1982675021

  OR

  Medicare reassignment NPD
• Martin Fuss, M.D.

  • Radiation Oncology Physician
  • Woonsocket, RI
  • NPI 1710990312

  OR

  Medicare reassignment NPD
• Edward G. Atkin, MD

  • Dermatology Physician
  • Hillsboro, OR
  • NPI 1013082213
  NPD (past)
• Matthew Raymond Gee, M.D.

  • Dermatology Physician
  • Maple Valley, WA
  • NPI 1306835764
  NPD (past)

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

{
    "created_epoch": "1194480000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1265155200000",
    "number": "1710167689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17704 JEAN WAY",
            "address_2": "SUITE 102",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970355497",
            "telephone_number": "503-635-9221",
            "fax_number": "503-635-5902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17704 JEAN WAY",
            "address_2": "SUITE 102",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970355497",
            "telephone_number": "503-635-9221",
            "fax_number": "503-635-5902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE OSWEGO DERMATOLOGY GROUP, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-08",
        "last_updated": "2010-02-03",
        "status": "A",
        "authorized_official_last_name": "SHIGETA",
        "authorized_official_first_name": "RITA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "503-635-9221",
        "authorized_official_name_suffix": "II"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lake Grove ENT PC
• Lake Grove Family Medical Clinic LLC
• Lake Grove Wellness
• Lake Medical Clinic, Inc.
• Lake Oswego Chiropractic Clinic, P.C.
• Lake Oswego Family Physicians
• Lake Oswego Foot Clinic
• Lake Oswego Health Center
• Lake Oswego Health Center
• Lake Oswego Massage Therapy

• Dermatology Physician in Lake Oswego, OR
• Providers in Lake Oswego, OR by specialty
• Dermatology Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2010; 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.