NPIMap

Individual provider Active NPI

Samuel Gardner Shiley, MD

  • Otolaryngology Physician
  • Portland, OR
National Provider Identifier
1861429227
Registry record updated Jun 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
MD25260 Issued in OR
Practice address
2701 NW Vaughn St Ste 150
Portland, OR 97210-5379
Phone
(503) 229-8455
Fax
(503) 229-7028
NPI assigned
Jun 28, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X MD25260 OR Primary

Addresses

Primary practice location

2701 NW Vaughn St Ste 150
Portland, OR 97210-5379

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
2059958MedicaidWA
269657MedicaidOR

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address cc_otoc_ent_nw_good_sam_front_desk_pool12223127@oc.providencedirect.org The Oregon Clinic PC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041101000650 OR Practitioner - Otolaryngology 3678535762 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
University of California, Irvine, California College of Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
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

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD25260ORMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Oregon Clinic, PC CurrentSince Jun 1, 2016 Accepting new patients
The Oregon Clinic PC Current Accepting new patients
Oregon Clinic PC CurrentSince Jun 1, 2016 Accepting new patients

Locations

847 NE 19th Ave
Ste 300
Portland, OR 97232

2701 NW Vaughn St
Ste 150
Portland, OR 97210
Phone (503) 229-8455

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

2222 NW Lovejoy St
Ste 622
Portland, OR 97210
Phone (503) 229-8455

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

500 N Highway
Saint Helens, OR 97051
Phone (503) 229-7554

Interoperability endpoints

  • Direct secure messaging: sshiley102622@oc.providencedirect.org

Organizations & group practices 3

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 10

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": "1151452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750377600000",
    "number": "1861429227",
    "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": "2701 NW VAUGHN ST STE 150",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972105379",
            "telephone_number": "503-229-8455",
            "fax_number": "503-229-7028"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHILEY",
        "first_name": "SAMUEL",
        "middle_name": "GARDNER",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-28",
        "last_updated": "2025-06-20",
        "certification_date": "2025-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "OR",
            "license": "MD25260",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2059958",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "269657",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cc_otoc_ent_nw_good_sam_front_desk_pool12223127@oc.providencedirect.org",
            "affiliation": "Y",
            "affiliationName": "The Oregon Clinic PC",
            "address_1": "2222 NW Lovejoy St",
            "address_2": "Suite #622",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972103033",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.