NPIMap

Individual provider Active NPI

Edward Patrick Fenlon III, MD

  • Diagnostic Radiology Physician
  • Philadelphia, PA
National Provider Identifier
1760827513
Registry record updated May 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
MD214095 Issued in OR
Practice address
3400 Spruce St
Philadelphia, PA 19104-4206
Phone
(215) 662-3264
NPI assigned
May 7, 2013
Last updated
May 8, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 8, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X MT203888 PA
Diagnostic Radiology Physician 2085R0202X MD214095 OR Primary

Addresses

Primary practice location

3400 Spruce St
Philadelphia, PA 19104-4206

Mailing address

PO Box 3409
Portland, OR 97208-3409
Phone (215) 662-3264

Other practice location 1

2801 N Gantenbein Ave
Portland, OR 97227
Phone (503) 413-4032

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
I20230428000794 OR Practitioner - Diagnostic Radiology 2365797677 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Georgetown University School of Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pacific Imaging Associates LLCGroup PAC ID 3577923499, 69 clinicians
TS Radiology Billings LLCGroup PAC ID 0840221230, 14 clinicians

Practice addresses (Care Compare)

1000 3Rd St
Tillamook, OR 97141-3430
Phone (503) 815-2260

1015 NW 22ND Ave
Portland, OR 97210-3025
Phone (503) 413-7800

19250 SW 65TH Ave
Suite 300
Tualatin, OR 97062-7707
Phone (503) 413-7800

24800 SE Stark St
Gresham, OR 97030-3378
Phone (503) 413-7800

25050 SE Stark St
Gresham, OR 97030-3388

2725 SW Cedar Hills Blvd
Suite 225
Beaverton, OR 97005-1416
Phone (503) 413-7800

2801 N Gantenbein Ave
Portland, OR 97227-1623
Phone (971) 340-2758

36860 Industrial Way
Sandy, OR 97055-7371
Phone (503) 826-0206

475 S Columbia River Hwy
Saint Helens, OR 97051-2859
Phone (503) 413-7800

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
99.66 of 100Reported as group
Quality
97.85
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
83.81 of 100Reported as group
Quality
71.23
Promoting interoperability
88
Improvement activities
40
Cost
81.9

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD214095ORMDDiagnostic Radiology Physician
MT203888PAMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pacific Imaging Associates LLC Diagnostic Radiology CurrentSince Jul 1, 2023 Accepting new patients
Northwest Medical Foundation of Tillamook Current Accepting new patients
Northwest Medical Foundation of Tillamook CurrentSince Dec 11, 2023 Accepting new patients
Northwest Medical Foundation of Tillamook CurrentSince Dec 11, 2023 Accepting new patients
Northwest Medical Foundation of Tillamook CurrentSince Jan 1, 2026 Accepting new patients
TS Radiology Billings, LLC Diagnostic Radiology CurrentSince Jun 1, 2023 Accepting new patients
Trustees of Columbia University in the City of New York Past Accepting new patients

Locations

2725 SW Cedar Hills Blvd
Ste 225
Beaverton, OR 97005

1015 NW 22nd Ave
Portland, OR 97210
Phone (503) 413-7582

2801 N Gantenbein Ave
Portland, OR 97227
Phone (503) 413-2200

475 S Columbia River Hwy
Saint Helens, OR 97051
Phone (503) 397-8040

342 Fairview St
Silverton, OR 97381
Phone (503) 525-7660

1000 3rd St
#M
Tillamook, OR 97141
Phone (503) 815-2260

1000 3rd St
Tillamook, OR 97141
Phone (503) 251-6129

19250 SW 65th Ave
Ste 300
Tualatin, OR 97062
Phone (503) 692-1242

Interoperability endpoints

  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/R4/
  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

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 12

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": "1367884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683504000000",
    "number": "1760827513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3409",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083409",
            "telephone_number": "215-662-3264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 SPRUCE ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044206",
            "telephone_number": "215-662-3264"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2801 N Gantenbein Ave",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "97227",
            "country_code": "US",
            "telephone_number": "503-413-4032",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FENLON",
        "first_name": "EDWARD",
        "middle_name": "PATRICK",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-05-07",
        "last_updated": "2023-05-08",
        "certification_date": "2023-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "PA",
            "license": "MT203888",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "OR",
            "license": "MD214095",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.