NPIMap

Individual provider Active NPI

Charles Thayer White Jr., M.D.

  • Family Medicine Physician
  • Portland, OR
National Provider Identifier
1740485432
Registry record updated Mar 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD151665 Issued in OR
Practice address
5330 NE Glisan St
Ste 100
Portland, OR 97213-3069
Phone
(503) 215-9700
Fax
(503) 215-9701
NPI assigned
Jun 20, 2007
Last updated
Mar 25, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD151665 OR Primary
Sports Medicine (Family Medicine) Physician 207QS0010X MD151665 OR

Addresses

Primary practice location

5330 NE Glisan St
Ste 100
Portland, OR 97213-3069

Mailing address

PO Box 3158
Portland, OR 97208-3158

Other identifiers 1

IdentifierTypeStateIssuer
025167MedicaidOR

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address cwhite133999@oc.providencedirect.org

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
I20110818000836 OR Practitioner - Family PracticePractitioner - Obstetrics/GynecologyPractitioner - Sports Medicine 9739359258 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Obstetrics/Gynecology, Sports Medicine
Education
University of North Carolina at Chapel Hill School of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

5050 NE Hoyt St
Suite 240
Portland, OR 97213-2981
Phone (503) 215-6480

5330 NE Glisan St
Portland, OR 97213-3069

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD151665ORMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services - Oregon CurrentSince Jul 1, 2015 Accepting new patients
Providence Health & Services Oregon Current Accepting new patients
Providence Health & Services - Oregon Family Medicine CurrentSince Jun 25, 2012 Accepting new patients
Providence Health & Services Oregon CurrentSince Jul 1, 2015 Accepting new patients
Providence Health & Services Oregon CurrentSince Jun 25, 2012 Accepting new patients
Providence Health & Services - Oregon Family Medicine Past Accepting new patients
Portland Clinic Family Medicine Past Accepting new patients

Locations

1321 NE 99th Ave
Ste 100
Portland, OR 97220
Phone (503) 215-4050

1321 NE 99th Ave
Ste 200
Portland, OR 97220
Phone (503) 215-4250

4805 NE Glisan St
Portland, OR 97213
Phone (503) 215-1111

5050 NE Hoyt St
Ste 240
Portland, OR 97213
Phone (503) 215-6480

5330 NE Glisan St
Ste 100
Portland, OR 97213
Phone (503) 215-9700

Interoperability endpoints

  • Direct secure messaging: cwhite133999@oc.providencedirect.org

Organizations & group practices 7

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": "1182297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616630400000",
    "number": "1740485432",
    "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": "5330 NE GLISAN ST",
            "address_2": "STE 100",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972133069",
            "telephone_number": "503-215-9700",
            "fax_number": "503-215-9701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITE",
        "first_name": "CHARLES",
        "middle_name": "THAYER",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-20",
        "last_updated": "2021-03-25",
        "certification_date": "2021-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "MD151665",
            "primary": true
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "OR",
            "license": "MD151665",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "025167",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cwhite133999@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "5330 NE Glisan St",
            "address_2": "STE 100",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972133069",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.