Patan Gultawatvichai, M.D.

Primary specialty

Hematology & Oncology PhysicianTaxonomy code 207RH0003X

License

MD221300 Issued in OR

Practice address

9495 SW Locust St Ste G
Portland, OR 97223-6683

Phone

(971) 314-4522

Fax

(971) 314-4527

NPI assigned

Aug 7, 2012

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in MA, OR2 enrollments

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 2

Specialty

Hematology/Oncology

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Oncology Institute Or a Professional CorporationGroup PAC ID 0648719989, 4 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Umass Memorial Healthalliance Hospitals Hospital, Leominster, MA, CCN 220001
• Mercy Medical Center Hospital, Roseburg, OR, CCN 380027
• Legacy Meridian Park Medical Center Hospital, Tualatin, OR, CCN 380089
• Columbia Memorial Hospital Hospital, Astoria, OR, CCN 381320

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: patan.gultawatvichai@theoncologyinstitute.ikm.direct-ci.com
• Direct secure messaging: pgultawatvichai28847@umassmemorial.direct-ci.com
• Direct secure messaging: patan.gultawatvichai.npi1720335987.reliant@direct.optumcare.masshiway.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Starling Oncology Or, a Professional Corporation

  • Hematology & Oncology Physician
  • Portland, OR
  • NPI 1891536223
  Medicare reassignment Care Compare group NPD
• Reliant Medical Group, Inc

  • Family Medicine Physician
  • Worcester, MA
  • NPI 1720017528

  Hematology & Oncology

  Medicare reassignment NPD
• Starling Oncology Or, a Professional Corporation

  • Hematology & Oncology Physician
  • Salem, OR
  • NPI 1285472886
  NPD (past)
• The Oncology Institute Ca, a Professional Corporation

  • Hematology & Oncology Physician
  • Downey, CA
  • NPI 1275651515
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Columbia Lutheran Charities

  • Critical Access Hospital
  • Astoria, OR
  • NPI 1134146939
  Care Compare affiliation
• Columbia Lutheran Charities

  • Cardiovascular Disease Physician
  • Astoria, OR
  • NPI 1629378880

  Hospital

  Care Compare affiliation
• Columbia Lutheran Charities

  • Critical Access Hospital
  • Astoria, OR
  • NPI 1700809761
  Care Compare affiliation
• Columbia Lutheran Charities

  • Surgery Physician
  • Astoria, OR
  • NPI 1821254129

  Hospital

  Care Compare affiliation
• Columbia Lutheran Charities

  • Surgery Physician
  • Astoria, OR
  • NPI 1871747659

  Hospital

  Care Compare affiliation
• Commonspirit Oregon

  • General Acute Care Hospital
  • Roseburg, OR
  • NPI 1477590198
  Care Compare affiliation
• Legacy Meridian Park Hospital

  • General Acute Care Hospital
  • Tualatin, OR
  • NPI 1184647620
  Care Compare affiliation
• Umass Memorial Healthalliance Clinton Hospital Inc

  • General Acute Care Hospital
  • Leominster, MA
  • NPI 1013995133
  Care Compare affiliation
• Umass Memorial Healthalliance Clinton Hospital Inc

  • Psychiatric Hospital Unit
  • Clinton, MA
  • NPI 1285171934
  Care Compare affiliation

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

{
    "created_epoch": "1344297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732665600000",
    "number": "1720335987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 NEPONSET ST",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016062714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9495 SW LOCUST ST STE G",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972236683",
            "telephone_number": "971-314-4522",
            "fax_number": "971-314-4527"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5 Neponset St",
            "address_purpose": "LOCATION",
            "city": "Worcester",
            "state": "MA",
            "postal_code": "016062714",
            "country_code": "US",
            "telephone_number": "508-556-5400",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "55 Lake Ave N",
            "address_purpose": "LOCATION",
            "city": "Worcester",
            "state": "MA",
            "postal_code": "01655",
            "country_code": "US",
            "telephone_number": "508-334-3550",
            "fax_number": "774-442-6715",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2720 Commercial St SE",
            "address_purpose": "LOCATION",
            "city": "Salem",
            "state": "OR",
            "postal_code": "973024495",
            "country_code": "US",
            "telephone_number": "971-314-4522",
            "fax_number": "971-314-4527",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "275 Nichols Rd",
            "address_purpose": "LOCATION",
            "city": "Fitchburg",
            "state": "MA",
            "postal_code": "014201919",
            "country_code": "US",
            "telephone_number": "978-343-5048",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GULTAWATVICHAI",
        "first_name": "PATAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-08-07",
        "last_updated": "2024-11-27",
        "certification_date": "2024-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "OR",
            "license": "MD221300",
            "primary": true
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "MA",
            "license": "274829",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110115607A",
            "state": "MA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pgultawatvichai28847@UmassMemorial.direct-ci.com",
            "affiliation": "N",
            "address_1": "55 Lake Ave N",
            "city": "Worcester",
            "state": "MA",
            "country_code": "US",
            "postal_code": "01655",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0978.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "55 Lake Ave N",
            "city": "Worcester",
            "state": "MA",
            "country_code": "US",
            "postal_code": "01655",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Lily Gullion, MS, OTR/L
• Kristina Devin Gulliver, M.D.
• Gretchen Gulotta, MA
• Hiromi Gulpan
• Scott M Gulstine, PT
• Lindsey Joy Gulya
• Leah Gulyas, RN
• Quinn Linden Gumbiner, LMT
• Aika Shepard Gumboc, MD
• Christopher Allen Gumke, P.T.

• Hematology & Oncology Physician in Portland, OR
• Providers in Portland, OR by specialty
• Hematology & Oncology Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.