Individual provider Active NPI

Benjamin Pedroja, MD

  • Internal Medicine Physician
  • Portland, OR
National Provider Identifier
1821477910
Registry record updated Mar 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD186763 Issued in OR
Practice address
5050 NE Hoyt St
Suite 540
Portland, OR 97213-2985
Phone
(503) 215-6600
NPI assigned
May 22, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD186763 OR Primary

Addresses

Primary practice location

5050 NE Hoyt St
Suite 540
Portland, OR 97213-2985

Mailing address

PO Box 3158
Portland, OR 97208-3158

Other identifiers 1

IdentifierTypeStateIssuer
500743538MedicaidOR

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address bpedroja517583@oc.providencedirect.org
Direct Messaging Address bpedroja517583@oc.providencedirect.org

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
I20180531001899 OR Practitioner - Internal Medicine 5496069833 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
New York University School of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Providence Health and Services OregonGroup PAC ID 0648183608, 1,423 clinicians
Providence Health and Services - OregonGroup PAC ID 5395656284, 195 clinicians

Practice addresses (Care Compare)

4805 NE Glisan St
Portland, OR 97213-2933

5050 NE Hoyt St
Suite 240
Portland, OR 97213-2981
Phone (503) 215-6480

Hospital & facility affiliations

  • Providence Portland Medical Center Hospital, Portland, OR, CCN 380061

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services Oregon CurrentSince Jul 1, 2018 Accepting new patients
Providence Health & Services Oregon CurrentSince Jul 1, 2018 Accepting new patients
Providence Health & Services - Oregon CurrentSince Jul 1, 2018 Accepting new patients
Providence Health & Services - Oregon Internal Medicine CurrentSince Jul 1, 2018 Accepting new patients
Providence Health & Services Oregon Current Accepting new patients

Locations

5050 NE Hoyt St
Ste 454
Portland, OR 97213
Phone (503) 215-6405

5050 NE Hoyt St
Ste 240
Portland, OR 97213
Phone (503) 215-6480

5050 NE Hoyt St
Ste 540
Portland, OR 97213
Phone (503) 215-6600

4805 NE Glisan St
Portland, OR 97213
Phone (503) 215-1111

Organizations & group practices 5

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 2

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": "1432252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616544000000",
    "number": "1821477910",
    "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": "5050 NE HOYT ST",
            "address_2": "SUITE 540",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972132985",
            "telephone_number": "503-215-6600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEDROJA",
        "first_name": "BENJAMIN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-05-22",
        "last_updated": "2021-03-24",
        "certification_date": "2021-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "MD186763",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500743538",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bpedroja517583@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "5050 NE HOYT ST",
            "address_2": "SUITE 540",
            "city": "PORTLAND",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972132985",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bpedroja517583@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "4805 NE Glisan St",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972132933",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.