NPIMap

Organization Active NPI

Multnomah County

Doing business as Multnomah County Health Dept, Southeast

  • State or Local Public Health Clinic/Center
  • Portland, OR
National Provider Identifier
1720126816
Registry record updated Aug 28, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
State or Local Public Health Clinic/CenterTaxonomy code 261QP0905X
Legal business name
MULTNOMAH COUNTY
Doing business as
Multnomah County Health Dept, Southeast
Practice address
3653 SE 34TH Ave
Portland, OR 97202-3034
Phone
(503) 988-7462
Fax
(503) 988-3015
NPI assigned
Feb 2, 2007
Last updated
Aug 28, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2026

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

Authorized official

Name
Antoinette Payne
Title
Business Services Director
Phone
(971) 325-6412

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X OR
State or Local Public Health Clinic/Center 261QP0905X OR Primary

Addresses

Primary practice location

3653 SE 34TH Ave
Portland, OR 97202-3034

Mailing address

619 NW 6TH Ave Ste 500
Portland, OR 97209-3964
Phone (503) 988-7468

Other identifiers 2

IdentifierTypeStateIssuer
022959MedicaidOR
096511MedicaidOR

Other names 1

  • Multnomah County Health Dept, Southeast Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031203000025 OR Part B Supplier - Clinic/Group Practice 6608771787 Receives reassigned benefits from 241 practitioners
19 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Portland, OR; Gresham, OR
O20090414000219 OR Part A Provider - Federally Qualified Health Center (FQHC) 6608771787 Practice locations: Portland, OR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1720126816. Details of each certification follow.

Federally qualified health center certification: CCN 381830

Legal name
MULTNOMAH COUNTY
Doing business as
MULTNOMAH COUNTY HEALTH DEPARTMENT
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 15, 1998
Last certification
Jan 15, 1998
Ownership / control type
Non-profit – corporation
Organization structure
GovernmentNon-profit
Incorporated
Dec 22, 1854 in OR
Enrollment address
3653 SE 34TH Ave
Portland, OR 97202-3034

Other NPIs with the same Medicare PAC ID 8

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

  • Multnomah County

    dba Multnomah County Health Dept,Mid County

    • Federally Qualified Health Center (FQHC)
    • Portland, OR
    • NPI 1245378322

    6608771787

    Same PAC ID
  • Multnomah County

    dba Multnomah County Health Dept, Northeast

    • Federally Qualified Health Center (FQHC)
    • Portland, OR
    • NPI 1427196500

    6608771787

    Same PAC ID
  • Multnomah County

    dba Fernhill Health Center

    • Federally Qualified Health Center (FQHC)
    • Portland, OR
    • NPI 1508904681

    6608771787

    Same PAC ID
  • Multnomah County

    dba East County Health Center

    • Federally Qualified Health Center (FQHC)
    • Gresham, OR
    • NPI 1518005693

    6608771787

    Same PAC ID
  • Multnomah County

    dba Multnomah County Health Dept, North Portland

    • Federally Qualified Health Center (FQHC)
    • Portland, OR
    • NPI 1609914787

    6608771787

    Same PAC ID
  • Multnomah County

    dba Multnomah County Health Department, Rockwood

    • Federally Qualified Health Center (FQHC)
    • Portland, OR
    • NPI 1912226325

    6608771787

    Same PAC ID
  • Multnomah County
    • Federally Qualified Health Center (FQHC)
    • Gresham, OR
    • NPI 1912322074

    6608771787

    Same PAC ID
  • Multnomah County

    dba Multnomah County Health Department HIV Clinic

    • Federally Qualified Health Center (FQHC)
    • Portland, OR
    • NPI 1982992954

    6608771787

    Same PAC ID

Other NPIs on the same Medicare enrollment 18

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 18

National Provider Directory

National Provider Directory
Tax ID family
Multicare Dental Dco89 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

5329 NE Mlk Jr Blvd
Portland, OR 97211
Phone (503) 988-3821

Ownership & related parties

All disclosed owners & managing parties 5

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Aline Blumenauer Individual W-2 Managing EmployeeFinance Manager Dec 1, 2023 50%
Derrick Moten Individual Corporate DirectorDeputy Director Dec 1, 2023 100%
Multnomah County Organization, Portland, OR Other Jan 1, 2015 100%
Sandra Pugh Individual W-2 Managing EmployeeBusiness Process Consultant Aug 1, 2020 50%
Rachael Banks Individual Corporate DirectorDirector Dec 1, 2023 100%

Owners & managing parties with NPI records 8

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 8

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Multnomah County Health DepartmentPortland, OR, CCN 381827 Federally qualified health center Other (100%) Jan 1, 2011
Multnomah County Health DepartmentPortland, OR, CCN 381828 Federally qualified health center Other (100%) Jan 15, 1998
Multnomah County Health DepartmentPortland, OR, CCN 381829 Federally qualified health center Other (100%) Oct 1, 2011
Multnomah County Health DepartmentPortland, OR, CCN 381832 Federally qualified health center Other (100%) Oct 1, 2011
Multnomah County Health DepartmentPortland, OR, CCN 381833 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 15, 1998
HIV Health ServicesPortland, OR, CCN 381925 Federally qualified health center Other (100%) Jan 15, 1998
Multnomah County Health DepartmentGresham, OR, CCN 381926 Federally qualified health center Operational/Managerial Control (100%)
Other		 Oct 21, 2011
Apr 1, 2019
Centennial School BaseGresham, OR, CCN 381030 Federally qualified health center Operational/Managerial Control (100%) Dec 1, 2023

Owned or controlled facilities with NPI records 9

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • Multnomah County

    dba Multnomah County Health Dept,Mid County

    • Federally Qualified Health Center (FQHC)
    • Portland, OR
    • NPI 1245378322

    Other

    CMS ownership
  • Multnomah County

    dba Multnomah County Health Dept, Westside

    • Federally Qualified Health Center (FQHC)
    • Portland, OR
    • NPI 1336287416

    Other

    CMS ownership
  • Multnomah County

    dba Multnomah County Health Dept, Northeast

    • Federally Qualified Health Center (FQHC)
    • Portland, OR
    • NPI 1427196500

    Other

    CMS ownership
  • Multnomah County

    dba Fernhill Health Center

    • Federally Qualified Health Center (FQHC)
    • Portland, OR
    • NPI 1508904681

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • Multnomah County

    dba East County Health Center

    • Federally Qualified Health Center (FQHC)
    • Gresham, OR
    • NPI 1518005693

    Other

    CMS ownership
  • Multnomah County

    dba Multnomah County Health Dept, North Portland

    • Federally Qualified Health Center (FQHC)
    • Portland, OR
    • NPI 1609914787

    Other

    CMS ownership
  • Multnomah County

    dba Multnomah County Health Department, Rockwood

    • Federally Qualified Health Center (FQHC)
    • Portland, OR
    • NPI 1912226325

    Operational/Managerial Control, Other

    CMS ownership
  • Multnomah County
    • Federally Qualified Health Center (FQHC)
    • Gresham, OR
    • NPI 1912322074

    Operational/Managerial Control

    CMS ownership
  • Multnomah County

    dba Multnomah County Health Department HIV Clinic

    • Federally Qualified Health Center (FQHC)
    • Portland, OR
    • NPI 1982992954

    Other

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 19

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.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1170374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1787875200000",
    "number": "1720126816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "619 NW 6TH AVE STE 500",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972093964",
            "telephone_number": "503-988-7468",
            "fax_number": "503-988-3015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3653 SE 34TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972023034",
            "telephone_number": "503-988-7462",
            "fax_number": "503-988-3015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MULTNOMAH COUNTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-02",
        "last_updated": "2026-08-28",
        "certification_date": "2026-08-28",
        "status": "A",
        "authorized_official_last_name": "PAYNE",
        "authorized_official_first_name": "ANTOINETTE",
        "authorized_official_title_or_position": "BUSINESS SERVICES DIRECTOR",
        "authorized_official_telephone_number": "971-325-6412"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "OR",
            "license": null,
            "primary": false
        },
        {
            "code": "261QP0905X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Public Health, State or Local",
            "state": "OR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "022959",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "096511",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Multnomah County Health Dept, Southeast",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Multnomah County Health Dept, Southeast",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.