Individual provider Active NPI

Marc A Zenoniani, MD

  • Internal Medicine Physician
  • Canby, OR
National Provider Identifier
1801802392
Registry record updated Sep 29, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD26839 Issued in OR
Practice address
1185 South Elm St
Canby, OR 97013
Phone
(503) 723-4660
Fax
(503) 266-6649
NPI assigned
Aug 1, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 29, 2010

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD26839 OR Primary
Pediatrics Physician 208000000X MD26839 OR

Addresses

Primary practice location

1185 South Elm St
Canby, OR 97013

Mailing address

6 Centerpointe Dr Ste 200
Lake Oswego, OR 97035-8660
Phone (503) 797-2273

Other identifiers 1

IdentifierTypeStateIssuer
240159MedicaidOR

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
I20061226000004 OR Practitioner - Internal MedicinePractitioner - Pediatric Medicine 5597765560 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Pediatric Medicine
Education
Loma Linda University School of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

10100 SE Sunnyside Rd
Clackamas, OR 97015-8970
Phone (800) 813-2000

10180 SE Sunnyside Rd
Clackamas, OR 97015-8970
Phone (800) 813-2000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD26839ORMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kaiser Foundation Health Plan of the Northwest Internal Medicine CurrentSince Aug 25, 2012 Accepting new patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Aug 25, 2012 Accepting new patients
Pacific Medical Group, PC Past Accepting new patients

Locations

10180 SE Sunnyside Rd
Clackamas, OR 97015
Phone (503) 571-2880

10100 SE Sunnyside Rd
Clackamas, OR 97015
Phone (503) 571-2946

2400 Lancaster Dr NE
Salem, OR 97305
Phone (503) 361-5400

Interoperability endpoints

  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.61288

Organizations & group practices 3

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.

Hospital & facility affiliations 1

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": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1285718400000",
    "number": "1801802392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 CENTERPOINTE DR STE 200",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970358660",
            "telephone_number": "503-797-2273",
            "fax_number": "503-234-8155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1185 SOUTH ELM ST",
            "city": "CANBY",
            "state": "OR",
            "postal_code": "97013",
            "telephone_number": "503-723-4660",
            "fax_number": "503-266-6649"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZENONIANI",
        "first_name": "MARC",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-01",
        "last_updated": "2010-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "MD26839",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OR",
            "license": "MD26839",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "240159",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Canby, OR

Sources for this page

Verify at the official NPI Registry.