Active NPI
Sandra Ann Collis, DO
- Obstetrics & Gynecology Physician
- Gresham, OR
National Provider Identifier
1841208972
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Obstetrics & Gynecology Physician
- License
- DO19348
- Practice address
- 24850 SE Stark St
Suite 200
Gresham, OR 97030-8316 - Phone
- (503) 491-9444
- Fax
- (503) 661-1420
- NPI assigned
- Aug 4, 2006
- Last updated
- Jan 26, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | DO19348 | OR | Primary |
Addresses
Primary practice location
24850 SE Stark St
Suite 200
Gresham, OR 97030-8316
Mailing address
24850 SE Stark St
Suite 200
Gresham, OR 97030-8316
Phone (503) 491-9444
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 074216 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
Interoperability endpoints
- scollis9737@direct.lhs.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154649600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1327536000000",
"number": "1841208972",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24850 SE STARK ST",
"address_2": "SUITE 200",
"city": "GRESHAM",
"state": "OR",
"postal_code": "970308316",
"telephone_number": "503-491-9444",
"fax_number": "503-661-1420"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24850 SE STARK ST",
"address_2": "SUITE 200",
"city": "GRESHAM",
"state": "OR",
"postal_code": "970308316",
"telephone_number": "503-491-9444",
"fax_number": "503-661-1420"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COLLIS",
"first_name": "SANDRA",
"middle_name": "ANN",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-04",
"last_updated": "2012-01-26",
"status": "A"
},
"taxonomies": [
{
"code": "207V00000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology",
"state": "OR",
"license": "DO19348",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "074216",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Gresham, OR
- Alinne G Colin Valenzuela, CNM
- Stephanie Collado, BA
- Christina H Collier, QMHA-I
- Kathryn Collins, DPT
- Stephanie Collins, BA IN PSYCHOLOGY
- Columbia Medical and Endocrine Clinic
- Columbia Pain and Spine Institute
- Columbia Pain and Spine Institute
- Columbia River Dentistry-Gresham, LLC
- Columbia Surgical Specialists PLLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2012; 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.