NPIMap

Organization Active NPI

Head & Neck Surgical Associates, PC

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Portland, OR
National Provider Identifier
1821153941
Registry record updated May 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X
Legal business name
HEAD & NECK SURGICAL ASSOCIATES, PC
Practice address
1849 NW Kearney St Ste 300
Portland, OR 97209-1453
Phone
(503) 224-1371
Fax
(503) 224-0722
NPI assigned
Dec 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 21, 2021

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

Authorized official

Name
Shannon Gresh
Title
Clinic Operations Manager
Phone
(503) 224-1371

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Oral & Maxillofacial Surgery (D.M.D.)Group: 193200000X MULTI-SPECIALTY GROUP 204E00000X OR Primary
Otology & Neurotology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207YX0901X OR

Addresses

Primary practice location

1849 NW Kearney St Ste 300
Portland, OR 97209-1453

Mailing address

1849 NW Kearney St
Suite 300
Portland, OR 97209-1453
Phone (503) 224-1371

Other identifiers 1

IdentifierTypeStateIssuer
286589MedicaidOR

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040316000167 OR Part B Supplier - Clinic/Group Practice 4486544418 Receives reassigned benefits from 6 practitioners
Practice locations: Portland, OR

National Provider Directory

National Provider Directory

Locations

1849 NW Kearney St
Ste 300
Portland, OR 97209
Phone (503) 224-1371

1849 NW Kearney St
Ste 200
Portland, OR 97209
Phone (503) 553-3664

5050 NE Hoyt St
Ste 322
Portland, OR 97213
Phone (503) 230-0322

300 N Graham St
Ste 12
Portland, OR 97227

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1167177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621555200000",
    "number": "1821153941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1849 NW KEARNEY ST",
            "address_2": "SUITE 300",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972091453",
            "telephone_number": "503-224-1371",
            "fax_number": "503-224-0722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1849 NW KEARNEY ST STE 300",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972091453",
            "telephone_number": "503-224-1371",
            "fax_number": "503-224-0722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEAD & NECK SURGICAL ASSOCIATES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-27",
        "last_updated": "2021-05-21",
        "certification_date": "2021-05-21",
        "status": "A",
        "authorized_official_last_name": "GRESH",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_title_or_position": "CLINIC OPERATIONS MANAGER",
        "authorized_official_telephone_number": "503-224-1371"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "OR",
            "license": null,
            "primary": true
        },
        {
            "code": "207YX0901X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology, Otology & Neurotology",
            "state": "OR",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "286589",
            "state": "OR"
        }
    ],
    "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 May 21, 2021; 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.