NPIMap

Organization Active NPI

Northwest Primary Care Group PC

  • Family Medicine Physician
  • Milwaukie, OR
National Provider Identifier
1801856737
Registry record updated Jun 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
NORTHWEST PRIMARY CARE GROUP PC
Practice address
3033 SE Monroe St
Milwaukie, OR 97222-6636
Phone
(503) 659-4988
Fax
(503) 659-4730
NPI assigned
Mar 24, 2006
Last updated
Jun 3, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2020

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

Authorized official

Name
Mr. Michael Whitbeck
Title
Administrator
Phone
(503) 659-4777

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X
Family Medicine Physician 207Q00000X Primary
Sports Medicine (Family Medicine) Physician 207QS0010X
Durable Medical Equipment & Medical Supplies 332B00000X
Family Nurse Practitioner 363LF0000X

Addresses

Primary practice location

3033 SE Monroe St
Milwaukie, OR 97222-6636

Mailing address

PO Box 22075
Milwaukie, OR 97269-2075
Phone (503) 659-4777

Other identifiers 4

IdentifierTypeStateIssuer
226667MedicaidOR
38D0624619OtherORCLIA
500620283MedicaidOR
CE8055OtherORRAILROAD GROUP PTAN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040219000947 OR Part B Supplier - Clinic/Group Practice 0244125052 Receives reassigned benefits from 51 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Happy Valley, OR; Milwaukie, OR; Oregon City, OR; Portland, OR; West Linn, OR

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
38D2002858Northwest Primary Care Group MFP3033 SE Monroe, Milwaukie, OR 97222Certificate of waiverJan 26, 2028

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 41

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 41

NPI Registry JSON

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

{
    "created_epoch": "1143158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591142400000",
    "number": "1801856737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22075",
            "city": "MILWAUKIE",
            "state": "OR",
            "postal_code": "972692075",
            "telephone_number": "503-659-4777",
            "fax_number": "503-652-5223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3033 SE MONROE ST",
            "city": "MILWAUKIE",
            "state": "OR",
            "postal_code": "972226636",
            "telephone_number": "503-659-4988",
            "fax_number": "503-659-4730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST PRIMARY CARE GROUP PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-24",
        "last_updated": "2020-06-03",
        "certification_date": "2020-06-03",
        "status": "A",
        "authorized_official_last_name": "WHITBECK",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "503-659-4777",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "226667",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "38D0624619",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500620283",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD GROUP PTAN",
            "identifier": "CE8055",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukie, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.