NPIMap

Organization Active NPI

Pioneer Family Medicine PC

  • Family Medicine Physician
  • Canby, OR
National Provider Identifier
1760654479
Registry record updated Jun 18, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD21648 Issued in OR
Legal business name
PIONEER FAMILY MEDICINE PC
Practice address
452 NW 1St Ave
Canby, OR 97013-3532
Phone
(503) 266-9000
Fax
(503) 266-9200
NPI assigned
Apr 2, 2008
Last updated
Jun 18, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2008

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

Authorized official

Name
Shawn A Ewbank, M.D.NPI 1326039892
Title
President
Phone
(503) 266-9000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD21648 OR Primary

Addresses

Primary practice location

452 NW 1St Ave
Canby, OR 97013-3532

Mailing address

452 NW 1St Ave
Canby, OR 97013-3532
Phone (503) 266-9000

Other identifiers 1

IdentifierTypeStateIssuer
133934MedicaidOR

National Provider Directory

National Provider Directory

Locations

452 NW 1st Ave
Canby, OR 97013
Phone (503) 266-7443

Practitioners & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1207094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213747200000",
    "number": "1760654479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "452 NW 1ST AVE",
            "city": "CANBY",
            "state": "OR",
            "postal_code": "970133532",
            "telephone_number": "503-266-9000",
            "fax_number": "503-266-9200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "452 NW 1ST AVE",
            "city": "CANBY",
            "state": "OR",
            "postal_code": "970133532",
            "telephone_number": "503-266-9000",
            "fax_number": "503-266-9200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PIONEER FAMILY MEDICINE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-02",
        "last_updated": "2008-06-18",
        "status": "A",
        "authorized_official_last_name": "EWBANK",
        "authorized_official_first_name": "SHAWN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "503-266-9000",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "MD21648",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "133934",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Canby, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2008; 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.