Individual provider Active NPI

Ellen Annette Hall, MD

  • Pediatrics Physician
  • Beaverton, OR
National Provider Identifier
1760570592
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
MD15640 Issued in OR
Practice address
4855 SW Western Ave
Beaverton, OR 97005-3460
Phone
(503) 643-7565
Fax
(503) 626-4415
NPI assigned
Oct 10, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X MD15640 OR Primary

Addresses

Primary practice location

4855 SW Western Ave
Beaverton, OR 97005-3460

Mailing address

4855 SW Western Ave
Beaverton, OR 97005-3460
Phone (503) 643-7565

Other names 1

  • Ellen Annette Hall-Chave Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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 1

Enrollment IDStateProvider typePAC IDDetails
I20130819000718 OR Practitioner - Pediatric Medicine 7113002320 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD15640ORMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Jun 18, 2013 Accepting new patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Jun 18, 2013 Accepting new patients
Kaiser Foundation Health Plan of the Northwest Pediatrics Current Accepting new patients

Locations

4855 SW Western Ave
Beaverton, OR 97005
Phone (503) 626-4148

10100 SE Sunnyside Rd
Clackamas, OR 97015
Phone (503) 571-2946

7201 N Interstate Ave
Portland, OR 97217
Phone (503) 240-4051

2400 Lancaster Dr NE
Salem, OR 97305
Phone (503) 361-5400

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1760570592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4855 SW WESTERN AVE",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970053460",
            "telephone_number": "503-643-7565",
            "fax_number": "503-626-4415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4855 SW WESTERN AVE",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970053460",
            "telephone_number": "503-643-7565",
            "fax_number": "503-626-4415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HALL",
        "first_name": "ELLEN",
        "middle_name": "ANNETTE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-10",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OR",
            "license": "MD15640",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELLEN",
            "last_name": "HALL-CHAVE",
            "middle_name": "ANNETTE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Beaverton, OR

Sources for this page

Verify at the official NPI Registry.