NPIMap

Organization Active NPI

Medication Management Program

  • Clinic Pharmacy
  • Portland, OR
National Provider Identifier
1720493968
Registry record updated Jun 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic PharmacyTaxonomy code 3336C0002X
License
2131 Issued in OR
Legal business name
MEDICATION MANAGEMENT PROGRAM
Doing business as
Medication Management Program
Practice address
5717 NE 138TH Ave
Portland, OR 97230-3409
Phone
(503) 261-7541
Fax
(503) 261-2048
NPI assigned
Jun 26, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2021

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

Authorized official

Name
Steve Logan
Title
Director, Pharmacy
Phone
(503) 261-7980

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic Pharmacy 3336C0002X 00058657 WA
Clinic Pharmacy 3336C0002X 2131 OR Primary

Addresses

Primary practice location

5717 NE 138TH Ave
Portland, OR 97230-3409

Mailing address

5717 NE 138TH Ave
Portland, OR 97230-3409
Phone (503) 261-7541

Other identifiers 3

IdentifierTypeStateIssuer
136668MedicaidOR
6019392MedicaidWA
2146486OtherPK

Other names 1

  • Medication Management Program Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/interconnect-prodnwm/wcf/epic.community.hie/xcpdrespondinggateways Health Information Exchange (HIE)

National Provider Directory

National Provider Directory
Tax ID family
Permananet Clinic150 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

NPI Registry JSON

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

{
    "created_epoch": "1403740800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622505600000",
    "number": "1720493968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5717 NE 138TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972303409",
            "telephone_number": "503-261-7541",
            "fax_number": "503-261-2048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5717 NE 138TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972303409",
            "telephone_number": "503-261-7541",
            "fax_number": "503-261-2048"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICATION MANAGEMENT PROGRAM",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-26",
        "last_updated": "2021-06-01",
        "certification_date": "2021-06-01",
        "status": "A",
        "authorized_official_last_name": "LOGAN",
        "authorized_official_first_name": "STEVE",
        "authorized_official_title_or_position": "DIRECTOR, PHARMACY",
        "authorized_official_telephone_number": "503-261-7980"
    },
    "taxonomies": [
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "WA",
            "license": "00058657",
            "primary": false
        },
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "OR",
            "license": "2131",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "136668",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6019392",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2146486",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/interconnect-prodnwm/wcf/epic.community.hie/xcpdrespondinggateways",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "5717 NE 138th Ave",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972303409",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Medication Management Program",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Medication Management Program",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.