NPIMap

Organization Active NPI

Portland Adventist Medical Center

Doing business as Adventist Health Medical Group

  • Family Medicine Physician
  • Portland, OR
National Provider Identifier
1750091021
Registry record updated Sep 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PORTLAND ADVENTIST MEDICAL CENTER
Doing business as
Adventist Health Medical Group
Practice address
10201 SE Main St Ste 10a
Portland, OR 97216-2937
Phone
(503) 261-6970
Fax
(503) 255-2194
NPI assigned
Nov 28, 2022
Last updated
Sep 23, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
PORTLAND ADVENTIST MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 23, 2025

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

Authorized official

Name
Jason Panasuk
Title
Finance Officer
Phone
(503) 261-4405

Specialties & licenses 15

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X
Family Medicine Physician 207Q00000X Primary
Internal Medicine Physician 207R00000X
Cardiovascular Disease Physician 207RC0000X
Endocrinology, Diabetes & Metabolism Physician 207RE0101X
Gastroenterology Physician 207RG0100X
Infectious Disease Physician 207RI0200X
Pulmonary Disease Physician 207RP1001X
Rheumatology Physician 207RR0500X
Radiation Oncology Physician 2085R0001X
Surgery Physician 208600000X
Vascular Surgery Physician 2086S0129X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X
Hospitalist Physician 208M00000X
Sleep Medicine (Psychiatry & Neurology) Physician 2084S0012X

Addresses

Primary practice location

10201 SE Main St Ste 10a
Portland, OR 97216-2937

Mailing address

PO Box 888928
Los Angeles, CA 90088-8928
Phone (503) 261-6095

Other names 1

  • Adventist Health Medical Group Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Bluemark LLC / Office Ally

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230412001327 OR Part B Supplier - Clinic/Group Practice 3274908819 Receives reassigned benefits from 339 practitioners
1 other NPI on this enrollment
Practice locations: Portland, OR; Sandy, OR; Tillamook, OR; Troutdale, OR; Clackamas, OR; Damascus, OR; Gresham, OR; McMinnville, OR

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Part of
Town Center Clinic

Locations

14530 SE Royer Rd
Damascus, OR 97089

831 NW Council Dr
Gresham, OR 97030

831 NW Council Dr
Ste 145
Gresham, OR 97030
Phone (503) 489-2650

9200 SE 91st Ave
#1
Happy Valley, OR 97086

10000 SE Main St
Ste 112
Portland, OR 97216
Phone (503) 255-3054

10000 SE Main St
Ste 316
Portland, OR 97216
Phone (503) 256-1575

10000 SE Main St
Ste 327
Portland, OR 97216
Phone (503) 256-5866

10101 SE Market St Ste 3001
Portland, OR 97216

10125 SE Market St
Portland, OR 97216

10201 SE Main St
Portland, OR 97216
Phone (503) 251-6141

10201 SE Main St
Ste 1
Portland, OR 97216
Phone (503) 261-6922

10201 SE Main St
Ste 10A
Portland, OR 97216
Phone (503) 255-2186

10201 SE Main St
Ste 10B
Portland, OR 97216
Phone (503) 255-7550

10201 SE Main St
Ste A
Portland, OR 97216

1350 NE 122nd Ave
#200
Portland, OR 97230

17055 Ruben Ln
Sandy, OR 97055
Phone (503) 668-8002

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 378

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 378

NPI Registry JSON

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

{
    "created_epoch": "1669593600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758585600000",
    "number": "1750091021",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 888928",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900888928",
            "telephone_number": "503-261-6095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10201 SE MAIN ST STE 10A",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972162937",
            "telephone_number": "503-261-6970",
            "fax_number": "503-255-2194"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTLAND ADVENTIST MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PORTLAND ADVENTIST MEDICAL CENTER",
        "enumeration_date": "2022-11-28",
        "last_updated": "2025-09-23",
        "certification_date": "2025-09-23",
        "status": "A",
        "authorized_official_last_name": "PANASUK",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "FINANCE OFFICER",
        "authorized_official_telephone_number": "503-261-4405"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RR0500X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Rheumatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084S0012X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Sleep Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.2019",
            "affiliationName": "Bluemark LLC / Office Ally",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "10201 SE Main St Ste 10A",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972162937",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Adventist Health Medical Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Adventist Health Medical Group",
            "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 Sep 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.