NPIMap

Organization Active NPI

Portland Wellness Care

  • Rehabilitation Clinic/Center
  • Portland, OR
National Provider Identifier
1801286117
Registry record updated Apr 29, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Clinic/CenterTaxonomy code 261QR0400X
License
261QR0400X Issued in OR
Legal business name
PORTLAND WELLNESS CARE
Practice address
4160 NE Sandy Blvd
Suite 1100
Portland, OR 97212-5336
Phone
(503) 249-9000
Fax
(503) 719-6829
NPI assigned
Jan 26, 2015
Last updated
Apr 29, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2015

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

Authorized official

Name
Dr. Mark E Hosko, M.D.NPI 1043233570
Title
Founder
Phone
(503) 249-9000

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
Rehabilitation Clinic/Center 261QR0400X 261QR0400X OR Primary

Addresses

Primary practice location

4160 NE Sandy Blvd
Suite 1100
Portland, OR 97212-5336

Mailing address

1647 SE Condor Ave
Gresham, OR 97080-7185
Phone (503) 730-8705

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150511000318 OR Part B Supplier - Clinic/Group Practice 6305165556 Receives reassigned benefits from 2 practitioners
Practice locations: Portland, OR

National Provider Directory

National Provider Directory

Locations

4160 NE Sandy Blvd
Ste 110
Portland, OR 97212
Phone (503) 249-9000

4160 NE Sandy Blvd
Ste 1100
Portland, OR 97212
Phone (503) 249-9000

Practitioners & affiliated clinicians

Practitioners 15

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.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1422230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430265600000",
    "number": "1801286117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1647 SE CONDOR AVE",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970807185",
            "telephone_number": "503-730-8705",
            "fax_number": "503-661-7488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4160 NE SANDY BLVD",
            "address_2": "SUITE 1100",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972125336",
            "telephone_number": "503-249-9000",
            "fax_number": "503-719-6829"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTLAND WELLNESS CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-26",
        "last_updated": "2015-04-29",
        "status": "A",
        "authorized_official_last_name": "HOSKO",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "FOUNDER",
        "authorized_official_telephone_number": "503-249-9000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": "OR",
            "license": "261QR0400X",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.