Bruce Leewiwatanakul, DO

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

DO219810 Issued in OR

Practice address

3181 SW Sam Jackson Park Rd.
Ohsu
Portland, OR 97239

Phone

(503) 494-8211

NPI assigned

Apr 4, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 6

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: bleewiwatanakul101712@direct.ohsu.edu

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.

• Legacy Emanuel Hospital & Health Center

  • General Acute Care Hospital
  • Portland, OR
  • NPI 1831112358
  Medicare reassignment NPD
• University Professional Services

  • General Practice Physician
  • Portland, OR
  • NPI 1376709535
  Medicare reassignment
• Legacy Emanuel Hospital & Health Center

  • Community/Retail Pharmacy
  • Portland, OR
  • NPI 1417977976
  NPD
• Legacy Emanuel Hospital & Health Center

  • Clinic/Center
  • Portland, OR
  • NPI 1700809027

  Pediatrics

  NPD
• University Professional Services

  • Multi-Specialty Clinic/Center
  • Portland, OR
  • NPI 1073767588
  NPD

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

{
    "created_epoch": "1491264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762732800000",
    "number": "1821521279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 SW 5TH AVE STE 500",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972015537",
            "telephone_number": "866-617-6855",
            "fax_number": "503-346-8015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3181 SW SAM JACKSON PARK RD.",
            "address_2": "OHSU",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97239",
            "telephone_number": "503-494-8211"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1225 NE 2nd Ave",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972322003",
            "country_code": "US",
            "telephone_number": "503-944-8000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3401 Civic Center Blvd Division of Post Peds Portal",
            "address_2": "Fellowship in General & Child and Adolescent Psychiatry",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "19104",
            "country_code": "US",
            "telephone_number": "215-327-4438",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LEEWIWATANAKUL",
        "first_name": "BRUCE",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-04-04",
        "last_updated": "2025-11-10",
        "certification_date": "2025-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "PA",
            "license": "OS021227",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "PA",
            "license": "OS021227",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OR",
            "license": "DO197940",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "OR",
            "license": "DO219810",
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "OR",
            "license": "DO219810",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brian David Leese, D.O.
• Christina Leese
• Angele Whinn Leetch, CADCR, CRM, PSS
• Christina Leetch
• Morgan Leets
• Katherine Lefco
• Jaime Beth Lefcovich, LDM, CPM
• Mariah Meyer Lefeber, MA LPC BC-DMT DTRL
• Izzy Lefebvre
• Maureen Lefere, MPT

• Child & Adolescent Psychiatry Physician in Portland, OR
• Providers in Portland, OR by specialty
• Child & Adolescent Psychiatry Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.