Individual provider Active NPI

Carl Bradford Anderson, M..D.

  • Occupational Medicine Physician
  • Portland, OR
National Provider Identifier
1871619080
Registry record updated Dec 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational Medicine PhysicianTaxonomy code 2083X0100X
License
MD181530 Issued in OR
Practice address
5050 NE Hoyt St Ste B48
Portland, OR 97213-2946
Phone
(503) 215-5458
NPI assigned
Mar 21, 2007
Last updated
Dec 2, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Medicine Physician 2083X0100X MD181530 OR Primary
Occupational Medicine Physician 2083X0100X 01037871A IN

Addresses

Primary practice location

5050 NE Hoyt St Ste B48
Portland, OR 97213-2946

Mailing address

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

Other practice location 1

10693 Brixton Ln
Fishers, IN 46037-8706
Phone (317) 755-7173

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, WA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20170713002016 OR Practitioner - Preventive Medicine 3173686110 Reassigns benefits to 3 organizations
I20170713003666 WA Practitioner - Preventive Medicine 3173686110 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01037871AINMDOccupational Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services Oregon Current Accepting new patients
Providence Health & Services Oregon Current Accepting new patients
Providence Health & Services Oregon CurrentSince Jun 10, 2024 Accepting new patients
Providence Health & Services - Oregon CurrentSince Jun 10, 2024 Accepting new patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Jun 19, 2017 Accepting new patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Jun 19, 2017 Accepting new patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Jun 19, 2017 Accepting new patients
Providence Health & Services - Oregon Current Accepting new patients

Locations

200 S Hazel Dell Way
Canby, OR 97013
Phone (203) 263-9500

10100 SE Sunnyside Rd
Clackamas, OR 97015
Phone (503) 571-2946

10100 SE Sunnyside Rd
Ofc
Clackamas, OR 97015
Phone (503) 571-3787

810 12th St
Hood River, OR 97031
Phone (541) 386-3911

917 11th St
Ste 200
Hood River, OR 97031
Phone (503) 963-3030

1001 N Providence Dr
Newberg, OR 97132
Phone (503) 216-1538

2400 Lancaster Dr NE
Salem, OR 97305
Phone (503) 361-5400

1230 7th Ave
Longview, WA 98632
Phone (360) 575-4801

7101 NE 137th Ave
Vancouver, WA 98682
Phone (360) 418-6000

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1174435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669939200000",
    "number": "1871619080",
    "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": "5050 NE HOYT ST STE B48",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972132946",
            "telephone_number": "503-215-5458"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10693 Brixton Ln",
            "address_purpose": "LOCATION",
            "city": "Fishers",
            "state": "IN",
            "postal_code": "460378706",
            "country_code": "US",
            "telephone_number": "317-755-7173",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "CARL",
        "middle_name": "BRADFORD",
        "credential": "M..D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-21",
        "last_updated": "2022-12-02",
        "certification_date": "2022-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2083X0100X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Occupational Medicine",
            "state": "OR",
            "license": "MD181530",
            "primary": true
        },
        {
            "code": "2083X0100X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Occupational Medicine",
            "state": "IN",
            "license": "01037871A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.