Knott Street Dermatology PC

Primary specialty

SpecialistTaxonomy code 174400000X

License

MD26393 Issued in OR

Legal business name

KNOTT STREET DERMATOLOGY PC

Practice address

301 NE Knott St
Portland, OR 97212-3014

Phone

(503) 253-2675

Fax

(503) 253-4297

NPI assigned

May 25, 2006

Last updated

Aug 13, 2014By 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

Dr. Eric Leif Hanson, MDNPI 1740259035

Title

President

Phone

(503) 253-3910

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/EFJBAA

Practitioners 8

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.

• Eric L Hanson, MD

  • Procedural Dermatology Physician
  • Portland, OR
  • NPI 1740259035
  Medicare reassignment Care Compare group NPD Authorized official
• Katie Conklin, ARNP

  • Family Nurse Practitioner
  • Portland, OR
  • NPI 1235546607
  Medicare reassignment Care Compare group NPD
• Krista Nicole Larson, M.D.

  • Dermatology Physician
  • Portland, OR
  • NPI 1245693902
  Medicare reassignment Care Compare group NPD
• Katherine Sandstrom, NP

  • Family Nurse Practitioner
  • Portland, OR
  • NPI 1982973095
  Medicare reassignment Care Compare group NPD
• Craig Schultz

  • Nurse Practitioner
  • Portland, OR
  • NPI 1619911559
  Medicare reassignment Care Compare group NPD
• Michael Anthony St Amand, PAC

  • Surgical Physician Assistant
  • Portland, OR
  • NPI 1023508751
  Medicare reassignment Care Compare group
• Charles Thomas Mauro IV, MD

  • Dermatology Physician
  • Hilo, HI
  • NPI 1205840469

  OR

  Medicare reassignment NPD
• Jessica Yoon, M.D.

  • Dermatology Physician
  • Longmont, CO
  • NPI 1831352418

  OR

  Medicare reassignment NPD

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

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1407888000000",
    "number": "1891741864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 NE KNOTT ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972123014",
            "telephone_number": "503-253-2675",
            "fax_number": "503-253-4297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 NE KNOTT ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972123014",
            "telephone_number": "503-253-2675",
            "fax_number": "503-253-4297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KNOTT STREET DERMATOLOGY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-25",
        "last_updated": "2014-08-13",
        "status": "A",
        "authorized_official_last_name": "HANSON",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "LEIF",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "503-253-3910",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "OR",
            "license": "MD26393",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Knoll
• Julie Ann Knoll, M.D.
• Lynn Knope, PSYD
• Colleen Knopf, LMT#28078
• Elizabeth Knorek, M.ED.
• Adam M Knott, MD
• Elsbeth Knott, MA
• Mary Knott
• Know Allergy LLC
• Andrew Knowles, PSYD

• Specialist in Portland, OR
• Providers in Portland, OR by specialty
• Specialist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.