Individual provider Active NPI

Mai'Ana Theresa Bamba Feuerborn, MD

  • Family Medicine Physician
  • Portland, OR
National Provider Identifier
1861134017
Registry record updated Oct 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD225267 Issued in OR
Practice address
4920 N Interstate Ave
Portland, OR 97217-3653
Phone
(503) 215-3300
Fax
(503) 215-3350
NPI assigned
Apr 8, 2022
Sex
Female
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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD225267 OR Primary

Addresses

Primary practice location

4920 N Interstate Ave
Portland, OR 97217-3653

Mailing address

PO Box 3158
Portland, OR 97208-3158
Phone (503) 215-6494

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20250909004737 OR Practitioner - Family Practice 5799165114 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Medical College of Wisconsin, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

4920 N Interstate Ave
Portland, OR 97217-3653
Phone (503) 215-3300

Hospital & facility affiliations

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
Providence Health & Services - Oregon Family Medicine CurrentSince Oct 5, 2025 Accepting new patients
Providence Health & Services Oregon CurrentSince Oct 5, 2025 Accepting new patients
Providence Health & Services - Oregon Family Medicine Past Accepting new patients

Locations

4104 SE 82nd Ave
Ste 250
Portland, OR 97266
Phone (503) 215-9850

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

4920 N Interstate Ave
Portland, OR 97217
Phone (503) 215-3300

Interoperability endpoints

  • Direct secure messaging: mfeuerborn2323991@oc.providencedirect.org

Organizations & group practices 4

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 2

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": "1649376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760400000000",
    "number": "1861134017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3158",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083158",
            "telephone_number": "503-215-6494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4920 N INTERSTATE AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972173653",
            "telephone_number": "503-215-3300",
            "fax_number": "503-215-3350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FEUERBORN",
        "first_name": "MAI'ANA",
        "middle_name": "THERESA BAMBA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-08",
        "last_updated": "2025-10-14",
        "certification_date": "2025-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "MD225267",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.