Poplar Hill Family Practice

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD08471 Issued in OR

Legal business name

POPLAR HILL FAMILY PRACTICE

Practice address

22490 SW Mountain Rd
West Linn, OR 97068-9619

Phone

(503) 638-8218

Fax

(503) 638-9698

NPI assigned

Dec 19, 2006

Organization subpart

No

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

Authorized official

Name

Robert Bastian Wagner, MDNPI 1730298647

Title

President

Phone

(503) 638-8218

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

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

• Robert Bastian Wagner, MD

  • Family Medicine Physician
  • West Linn, OR
  • NPI 1730298647
  NPD (past) Authorized official

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

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191888000000",
    "number": "1831253673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22490 SW MOUNTAIN RD",
            "city": "WEST LINN",
            "state": "OR",
            "postal_code": "970689619",
            "telephone_number": "503-638-8218",
            "fax_number": "503-638-9698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22490 SW MOUNTAIN RD",
            "city": "WEST LINN",
            "state": "OR",
            "postal_code": "970689619",
            "telephone_number": "503-638-8218",
            "fax_number": "503-638-9698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POPLAR HILL FAMILY PRACTICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-19",
        "last_updated": "2007-10-09",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "BASTIAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "503-638-8218",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "MD08471",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "214510",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lynne Christine Piazza-Vitek, LMT
• Megan Pierson, PT, DPT
• Maddison Rylie Pitzl
• Point of Action Physical Medicine LLC
• Andrew Polenske, PT, DPT, ATC
• Portland Dental Works, LLC
• Portland Vamc
• Patricia Posteuca
• Garry Cook Pow, D.C.
• Ronald Wayne Powell, D.O.

• Family Medicine Physician in West Linn, OR
• Providers in West Linn, OR by specialty
• Family Medicine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.