Individual provider Active NPI

Amanda Catherine Tep, DO

  • Student in an Organized Health Care Education/Training Program
  • Portland, OR
National Provider Identifier
1790314979
Registry record updated Jul 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
License
PG210936 Issued in OR
Practice address
9205 SW Barnes Rd Ste Mt2800
Portland, OR 97225-6603
Phone
(503) 216-2621
NPI assigned
Apr 8, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X PG210936 OR Primary

Addresses

Primary practice location

9205 SW Barnes Rd Ste Mt2800
Portland, OR 97225-6603

Mailing address

PO Box 3158
Portland, OR 97208-3158

Other practice location 1

200 Mullins Dr
Lebanon, OR 97355-3983
Phone (541) 259-0235

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
I20220623002456 OR Order and Referring Only - Internal MedicinePractitioner - Internal Medicine 8224417134

National Provider Directory

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

Interoperability endpoints

  • Direct secure messaging: atep1601104@oc.providencedirect.org
  • Direct secure messaging: amanda.tep.1@17650.direct.athenahealth.com

NPI Registry JSON

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

{
    "created_epoch": "1586304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658102400000",
    "number": "1790314979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3158",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9205 SW BARNES RD STE MT2800",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972256603",
            "telephone_number": "503-216-2621"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 Mullins Dr",
            "address_purpose": "LOCATION",
            "city": "Lebanon",
            "state": "OR",
            "postal_code": "973553983",
            "country_code": "US",
            "telephone_number": "541-259-0235",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TEP",
        "first_name": "AMANDA",
        "middle_name": "CATHERINE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-08",
        "last_updated": "2022-07-18",
        "certification_date": "2022-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "OR",
            "license": "PG210936",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.