NPIMap

Individual provider Active NPI

Timothy W. Mansour, M.D.

  • Surgery Physician
  • Portland, OR
National Provider Identifier
1851786727
Registry record updated Oct 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
MD225603 Issued in OR
Practice address
4805 NE Glisan St Ste 6N60
Portland, OR 97213-2933
Phone
(503) 935-8379
Fax
(503) 935-8940
NPI assigned
Mar 30, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X MD225603 OR Primary
Surgery Physician 208600000X 35715 AL

Addresses

Primary practice location

4805 NE Glisan St Ste 6N60
Portland, OR 97213-2933

Mailing address

541 NE 20TH Ave Ste 225
Portland, OR 97232-2895
Phone (503) 963-2801

Other practice location 1

4805 NE Glisan St Ste 6N40
Portland, OR 97213-2933
Phone (503) 215-7230

Other practice location 2

9155 SW Barnes Rd Ste 735
Portland, OR 97225-6634
Phone (503) 935-8379

Other identifiers 1

IdentifierTypeStateIssuer
500861299MedicaidOR

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address cc_otoc_cas_front_desk_pool12223192@or.providencedirect.org The Oregon Clinic PC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL, OR2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20210818003412 AL Practitioner - General Surgery 6406152255 Reassigns benefits to 1 organization
I20250905002304 OR Practitioner - General Surgery 6406152255 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
University of Oklahoma College of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
The Oregon Clinic, PCGroup PAC ID 2860390408, 353 clinicians

Practice addresses (Care Compare)

4805 NE Glisan
Portland, OR 97213-2933

5050 NE Hoyt
Suite 655
Portland, OR 97213-2990
Phone (503) 239-6673

Hospital & facility affiliations

  • Providence Portland Medical Center Hospital, Portland, OR, CCN 380061
  • Legacy Good Samaritan Medical Center Hospital, Portland, OR, CCN 380017
  • Providence St Vincent Medical Center Hospital, Portland, OR, CCN 380004
  • Providence Willamette Falls Medical Center Hospital, Oregon City, OR, CCN 380038
  • Columbia Memorial Hospital Hospital, Astoria, OR, CCN 381320

Merit-based Incentive Payment System (MIPS)

Final score
87.29 of 100Reported as group
Quality
69.72
Improvement activities
40
Cost
83.49

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hernia repair (minimally invasive)1-10
Upper gastrointestinal (GI) endoscopy for acid reflux45
Removal of tissue1-10
Skin biopsy1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services - Oregon Current Accepting new patients
Surgical Association of Mobile,P.a. Surgery CurrentSince Aug 23, 2021 Accepting new patients
The Oregon Clinic, PC CurrentSince Oct 1, 2025 Accepting new patients
The Oregon Clinic PC CurrentSince Oct 1, 2025 Accepting new patients
Providence Health & Services Oregon CurrentSince Oct 1, 2025 Accepting new patients
Providence Health & Service - Oregon CurrentSince Oct 1, 2025 Accepting new patients
Providence Health & Services Oregon Current Accepting new patients
Frontera Strategies, LLC PastSince Aug 1, 2021 Accepting new patients

Locations

3 Mobile Infirmary Cir
Ste 212
Mobile, AL 36607
Phone (205) 433-2609

440 NW Division St
Gresham, OR 97030
Phone (503) 215-9500

4805 NE Glisan St
Ste 6N40
Portland, OR 97213
Phone (503) 215-5696

5050 NE Hoyt St
Ste 655
Portland, OR 97213
Phone (503) 239-6673

4805 NE Glisan St
Ste 6N60
Portland, OR 97213
Phone (503) 281-0561

541 NE 20th Ave
Ste 225
Portland, OR 97232
Phone (503) 963-2801

1321 NE 99th Ave
Ste 200
Portland, OR 97220
Phone (503) 215-4250

9155 SW Barnes Rd
Ste 735
Portland, OR 97225
Phone (503) 297-4123

Interoperability endpoints

  • Direct secure messaging: tmansour1340861@oc.providencedirect.org

Organizations & group practices 8

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 12

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": "1427673600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760400000000",
    "number": "1851786727",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "541 NE 20TH AVE STE 225",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972322895",
            "telephone_number": "503-963-2801",
            "fax_number": "503-963-2825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4805 NE GLISAN ST STE 6N60",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972132933",
            "telephone_number": "503-935-8379",
            "fax_number": "503-935-8940"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4805 NE Glisan St Ste 6N40",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972132933",
            "country_code": "US",
            "telephone_number": "503-215-7230",
            "fax_number": "503-215-6240",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9155 SW Barnes Rd Ste 735",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972256634",
            "country_code": "US",
            "telephone_number": "503-935-8379",
            "fax_number": "503-935-8940",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MANSOUR",
        "first_name": "TIMOTHY",
        "middle_name": "W.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-03-30",
        "last_updated": "2025-10-14",
        "certification_date": "2025-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "OR",
            "license": "MD225603",
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "AL",
            "license": "35715",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500861299",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cc_otoc_cas_front_desk_pool12223192@or.providencedirect.org",
            "affiliation": "Y",
            "affiliationName": "The Oregon Clinic PC",
            "address_1": "4805 NE Glisan St Ste 6N60",
            "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.