Sam E Gruner, MD

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

MD18027 Issued in OR

Practice address

1015 NW 22ND Ave
Ste T-240
Portland, OR 97210-3025

Phone

(503) 413-7127

Fax

(503) 227-0218

NPI assigned

Jun 11, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Pacific Imaging Associates LLC

  • Diagnostic Radiology Physician
  • Portland, OR
  • NPI 1265137574
  NPD
• Northwest Urology, LLC

  • Specialist
  • Portland, OR
  • NPI 1629461397
  NPD (past)

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

{
    "created_epoch": "1149984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318809600000",
    "number": "1770525362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3730",
            "address_2": "DINW#103",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083730",
            "telephone_number": "800-878-6698",
            "fax_number": "918-665-4180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1015 NW 22ND AVE",
            "address_2": "STE T-240",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972103025",
            "telephone_number": "503-413-7127",
            "fax_number": "503-227-0218"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRUNER",
        "first_name": "SAM",
        "middle_name": "E",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-11",
        "last_updated": "2011-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "OR",
            "license": "MD18027",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "051461",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MD1805R",
            "state": "AK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "300101075",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8142721",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sarah Grumbling, LMT
• Maile Louise Grumm, LPC
• Alexis Grundler
• Cynthia Grundman
• Sara Joyce Clermont Grundy, MD
• Vanessa Grunewald
• David Morris Segouia Grunkemeier, MD
• Leslie Grush
• Elvira Grussenmeyer, LMT
• Teresa Gryder, N.D.

• Diagnostic Radiology Physician in Portland, OR
• Providers in Portland, OR by specialty
• Diagnostic Radiology Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2011; 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.