NPIMap

Individual provider Active NPI

Antonio Pena, MD

  • Specialist
  • Portland, OR
National Provider Identifier
1760531115
Registry record updated Jan 13, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
166613 Issued in OR
Practice address
5050 NE Hoyt St
Suite 203
Portland, OR 97213-2991
Phone
(503) 230-9224
Fax
(503) 230-9201
NPI assigned
Jan 8, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 22541 AZ
Specialist 174400000X 166613 OR Primary

Addresses

Primary practice location

5050 NE Hoyt St
Suite 203
Portland, OR 97213-2991

Mailing address

5050 NE Hoyt St
Suite 203
Portland, OR 97213-2991
Phone (503) 230-9224

Other identifiers 1

IdentifierTypeStateIssuer
168949MedicaidAZ

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
I20150423001697 OR Practitioner - Internal Medicine 1658357769 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Washington School of Medicine, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

5050 NE Hoyt St
Suite 203
Portland, OR 97213-2956
Phone (503) 230-9224

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
166613ORMDSpecialist
22541AZMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
NW Internal Medicine CurrentSince Sep 10, 2014 Accepting new patients
Internal Medicine of Oregon, LLC Internal Medicine Current Accepting new patients
Mid-Columbia Medical Center Family Medicine Past Accepting new patients

Locations

5050 NE Hoyt St
Ste 203
Portland, OR 97213
Phone (503) 230-9224

Interoperability endpoints

  • Direct secure messaging: apena630209@wm.providencedirect.org
  • Direct secure messaging: apena630249@oc.providencedirect.org

Organizations & group practices 4

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.

Hospital & facility affiliations 8

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": "1168214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1421107200000",
    "number": "1760531115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5050 NE HOYT ST",
            "address_2": "SUITE 203",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972132991",
            "telephone_number": "503-230-9224",
            "fax_number": "503-230-9201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5050 NE HOYT ST",
            "address_2": "SUITE 203",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972132991",
            "telephone_number": "503-230-9224",
            "fax_number": "503-230-9201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENA",
        "first_name": "ANTONIO",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-08",
        "last_updated": "2015-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AZ",
            "license": "22541",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "OR",
            "license": "166613",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "168949",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.