Modern Nose Clinic LLC

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

Legal business name

MODERN NOSE CLINIC LLC

Practice address

340 Vista Ave SE
Ste 100
Salem, OR 97302

Phone

(503) 584-1174

Fax

(503) 584-1330

NPI assigned

Apr 19, 2017

Last updated

Jul 20, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Douglas J Skarada, MDNPI 1770588949

Title

Medical Director

Phone

(503) 584-1174

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Modern Nose Clinic Former legal business name

Medicare fee-for-service enrollment

Enrolled in OR, WA2 enrollments

Enrollment records 2

Locations

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Modern Nose Clinic LLC

  • Otolaryngology Physician
  • Salem, OR
  • NPI 1043874696
  NPPES parent name

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Douglas Skarada, MD

  • Otolaryngology Physician
  • Salem, OR
  • NPI 1770588949

  WA

  Medicare reassignment Care Compare group NPD Authorized official
• Stephanie Warye, MPAS, PA-C

  • Medical Physician Assistant
  • Portland, OR
  • NPI 1265749188

  WA

  Medicare reassignment Care Compare group NPD
• Johnnie Machado, PA-C

  • Physician Assistant
  • Seattle, WA
  • NPI 1699051524
  Medicare reassignment Care Compare group NPD
• Eric T Waterman, MD

  • Otolaryngology Physician
  • Bellevue, WA
  • NPI 1093872947

  OR

  Medicare reassignment Care Compare group NPD
• Jenny L Hume, PA C

  • Physician Assistant
  • Portland, OR
  • NPI 1851387666
  Medicare reassignment Care Compare group
• Breanne Cannon, PA-C

  • Physician Assistant
  • Vancouver, WA
  • NPI 1003050071

  OR

  Medicare reassignment Care Compare group
• Nahmjee Lee Skarada, D.M.D.

  • General Practice Dentistry
  • Salem, OR
  • NPI 1629224365
  NPD

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

{
    "created_epoch": "1492560000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1784505600000",
    "number": "1851825566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "340 VISTA AVE SE",
            "address_2": "STE 100",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "97302",
            "telephone_number": "503-584-1174",
            "fax_number": "503-584-1330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 VISTA AVE SE",
            "address_2": "STE 100",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "97302",
            "telephone_number": "503-584-1174",
            "fax_number": "503-584-1330"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "19150 SW 90th Ave",
            "address_purpose": "LOCATION",
            "city": "Tualatin",
            "state": "OR",
            "postal_code": "970627624",
            "country_code": "US",
            "telephone_number": "503-584-1174",
            "fax_number": "503-584-1330",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "12402 SE 38th St Ste 202",
            "address_purpose": "LOCATION",
            "city": "Bellevue",
            "state": "WA",
            "postal_code": "980061214",
            "country_code": "US",
            "telephone_number": "425-656-4200",
            "fax_number": "425-656-4258",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "12402 SE 38th St Ste 201",
            "address_purpose": "LOCATION",
            "city": "Bellevue",
            "state": "WA",
            "postal_code": "980061214",
            "country_code": "US",
            "telephone_number": "425-656-4200",
            "fax_number": "425-656-4258",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MODERN NOSE CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-19",
        "last_updated": "2026-07-20",
        "certification_date": "2026-07-20",
        "status": "A",
        "authorized_official_last_name": "SKARADA",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "503-584-1174",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Otolaryngology",
            "state": "OR",
            "license": "23186",
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "287190",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Modern Nose Clinic",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Crystal Miyake, MSCCCA
• Samantha M Mize
• Zebedee Mize
• Mobility Solutions Prosthetics and Orthotics, LLC
• Modern Nose Clinic LLC
• Maya Modzelewska, M.D.
• Gordon H Moe, M.D.
• Mohammed Aboabid Mohammed
• Misha Mohindra, MD
• John M Moley, M.D.

• Otolaryngology Physician in Salem, OR
• Providers in Salem, OR by specialty
• Otolaryngology Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.