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Organization Active NPI

Providence Health & Services - Oregon

  • Case Manager/Care Coordinator
  • Portland, OR
National Provider Identifier
1891822995
Registry record updated May 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Manager/Care CoordinatorTaxonomy code 171M00000X
Legal business name
PROVIDENCE HEALTH & SERVICES - OREGON
Practice address
2705 E Burnside St
Suite 114
Portland, OR 97214-1763
Phone
(503) 215-6262
Fax
(503) 234-5437
NPI assigned
Feb 27, 2007
Organization subpart
Yes
Parent organization
PROVIDENCE PORTLAND MEDICAL CENTERAs reported in NPPES

Authorized official

NPPES NPI Registry
Name
Donald W Anderson Jr.
Title
Assistant Secretary Enrollments
Phone
(425) 358-9786

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Facilities connected through Provider of Services related, parent or unit certification numbers.

Affiliated clinicians 1,343

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 1,343

Care Compare: Hospital

Medicare Care Compare
Listed as
Providence Portland Medical CenterCCN 380061
Overall star rating
4 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Hospital certification: CCN 380061

Medicare enrollment files
Legal name
PROVIDENCE HEALTH & SERVICES - OREGON
Doing business as
PROVIDENCE PORTLAND MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Apr 11, 2025
Beds
483
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Feb 20, 1934 in OR
Enrollment address
4805 NE Glisan St
Portland, OR 97213-2933
Main/Primary Hospital Location
Hospital subgroups
General, Acute care

All disclosed owners & managing parties 26

Medicare enrollment files

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Diane L Hejna Individual Corporate DirectorBoard Member Jul 1, 2016
Richard S Blair Individual Corporate DirectorBoard Member Jul 1, 2016
Providence Health & Services-Oregon Organization, Renton, WA Non-profit 5% Or Greater Direct Ownership Interest May 17, 2010
Marvin O'Quinn Individual Corporate DirectorBoard Member Jan 1, 2024
Linda Buck Individual Corporate DirectorBoard Member Jan 1, 2025
Krista Farnham Individual W-2 Managing EmployeeChief Executive May 10, 2018
Providence Health & Services - Washington Organization, Renton, WA Corporation, Non-profit Operational/Managerial Control May 17, 2010
Mary E Lyons Individual Corporate DirectorBoard Member Jul 1, 2016
Phyllis M Hughes Individual Corporate DirectorBoard Member Jan 1, 2014
Rogelio Riojas Individual Corporate DirectorBoard Member Jan 1, 2025
James Martin Individual Corporate Officer Jan 13, 2023
Charles Wallace Sorenson Individual Corporate DirectorBRD MBR Jan 1, 2019
Kathryn C Buzbee Individual W-2 Managing EmployeeFinance Executive Jan 1, 2025
Donald Wayne Anderson Individual Corporate OfficerAssistant Secretary of Enrollments Aug 31, 2023
Gregory David Hoffman Individual Corporate OfficerCfo/Treasurer Jan 1, 2023
Isiaah D Crawford Individual Corporate DirectorBoard Member Jan 1, 2014
Melissa Ann Damm Individual W-2 Managing EmployeeOregon Cfo Jul 20, 2016
Donna Markham Individual Corporate DirectorBoard Member Jan 1, 2024
Michael W Murphy Individual Corporate DirectorBoard Member Jan 1, 2020
Providence Health & Services Organization, Renton, WA Non-profit Other Jul 1, 2016
Mary Beth Kingston Individual Corporate Director Sep 1, 2022
Eric D Sprunk Individual Corporate Director Jan 1, 2022
Anna R Newsom Individual Corporate Officer May 13, 2022
Darryl Elmouchi Individual Corporate OfficerPresident/Ceo Apr 1, 2025
Karin Dufault Individual Corporate DirectorBoard Member Jan 1, 2025
Providence St. Joseph Health Organization, Renton, WA Non-profit Other Jul 1, 2016

Medicare enrollment records 1

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
O20050713000608 OR Part a Provider - Hospital 5395656284 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Portland, OR; Newberg, OR; Gresham, OR

National Provider Directory

National Provider Directory
Part of
Mary Grant Anp

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care CoordinatorGroup: 193400000X SINGLE SPECIALTY GROUP 171M00000X Primary

Addresses

NPPES NPI Registry

Primary practice location

2705 E Burnside St
Suite 114
Portland, OR 97214-1763

Mailing address

PO Box 3395
Portland, OR 97208-3395
Phone (503) 215-4323

Other identifiers 2

NPPES NPI Registry
IdentifierTypeStateIssuer
054002MedicaidOR
824986000OtherORREGENCE CLINIC NUMBER

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on May 7, 2025.

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1746576000000",
    "number": "1891822995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3395",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083395",
            "telephone_number": "503-215-4323",
            "fax_number": "503-215-0297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2705 E BURNSIDE ST",
            "address_2": "SUITE 114",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972141763",
            "telephone_number": "503-215-6262",
            "fax_number": "503-234-5437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH & SERVICES - OREGON",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROVIDENCE PORTLAND MEDICAL CENTER",
        "enumeration_date": "2007-02-27",
        "last_updated": "2025-05-07",
        "certification_date": "2025-05-07",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY ENROLLMENTS",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "054002",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE CLINIC NUMBER",
            "identifier": "824986000",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.