Douglas P Blackall, MD
Individual provider Active NPI Clinical Pathology Physician · Portland, OR
NPI 1891885380 · NPPES record last updated Jan 15, 2021
Key facts
- NPI
- 1891885380
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Pathology Physician 207ZC0006X
- License
- MD202871 (OR)
- Practice address
- 4805 NE Glisan St
Portland, OR 97213-2933 - Phone
- (503) 215-6096
- NPI assigned
- Oct 13, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 29
Hospital & facility affiliations 7
Medicare Care Compare profile
- Specialty
- Pathology
- Education
- University of Arkansas College of Medicine, 1988
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Providence Health and Services - Oregon
Providence Health and Services Oregon
Providence Health and Services - Oregon
Providence Health and Services - Oregon
Providence Health and Services - Oregon
Providence Health and Services Oregon
Providence Health and Services Oregon
Providence Health and Services - Oregon
Practice addresses (Care Compare)
1001 N Providence Dr
Newberg, OR 97132-7485
Phone (503) 537-1555
10150 SE 32ND Ave
Milwaukie, OR 97222-6516
Phone (503) 513-8300
1111 Crater Lake Ave
Medford, OR 97504-6241
Phone (541) 732-5250
1500 Division St
Oregon City, OR 97045-1527
Phone (503) 656-1631
4805 NE Glisan St
Portland, OR 97213-2933
Phone (503) 215-1111
725 S Wahanna Rd
Seaside, OR 97138-7735
Phone (503) 717-7000
810 12TH St
Hood River, OR 97031-1587
Phone (541) 387-6445
9205 SW Barnes Rd
Portland, OR 97225-6603
Phone (503) 216-2213
Hospital & facility affiliations
- Providence St Vincent Medical Center
- Providence Portland Medical Center
- Providence Willamette Falls Medical Center
- Providence Medford Medical Center
- Providence Seaside Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 89.44 of 100
- Quality
- 87
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 73.18
Merit-based Incentive Payment System (MIPS)
- Final score
- 100 of 100
- Quality
- 100
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 96.73
Merit-based Incentive Payment System (MIPS)
- Final score
- 96.05 of 100
- Quality
- 96.63
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 79.14
Merit-based Incentive Payment System (MIPS)
- Final score
- 91.69 of 100
- Quality
- 84.88
- Promoting interoperability
- 100
- Improvement activities
- 40
Merit-based Incentive Payment System (MIPS)
- Final score
- 95.53 of 100
- Quality
- 96.2
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 84.49
Merit-based Incentive Payment System (MIPS)
- Final score
- 94.39 of 100
- Quality
- 83
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 89.32
Merit-based Incentive Payment System (MIPS)
- Final score
- 95 of 100
- Quality
- 83.34
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 100
Merit-based Incentive Payment System (MIPS)
- Final score
- 95.65 of 100
- Quality
- 98.12
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 80.38
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210114001726 | OR | Practitioner - Pathology | 0840192274 | Reassigns benefits to 10 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD202871 | OR | MD | Blood Banking & Transfusion Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Providence Health & Services Oregon | Current |
Accepting new patients | |
| Providence Health & Services - Oregon | Current | Accepting new patients | |
| Providence Health & Services Oregon | Current |
Accepting new patients | |
| Providence Health & Services Oregon | Clinical Pathology | Current |
Accepting new patients |
| Providence Health & Services Oregon | Current |
Accepting new patients | |
| Providence Health & Services - Oregon | Current | Accepting new patients | |
| Providence Health & Services - Oregon | Clinical Pathology | Current |
Accepting new patients |
| Providence Health & Services Oregon | Current |
Accepting new patients | |
| Providence Health & Services - Oregon | Current |
Accepting new patients | |
| Providence Health & Services Oregon | Current |
Accepting new patients | |
| Providence Health & Services - Oregon | Clinical Pathology | Current |
Accepting new patients |
| Providence Health & Services Oregon | Current |
Accepting new patients | |
| Providence Health & Services - Oregon | Current |
Accepting new patients | |
| Providence Health & Services - Oregon | Current | Accepting new patients | |
| Providence Health & Services - Oregon | Clinical Pathology | Current |
Accepting new patients |
| Providence Health & Services Oregon | Current |
Accepting new patients | |
| Providence Health & Services - Oregon | Clinical Pathology | Current |
Accepting new patients |
| SSM St. Joseph Endoscopy Center, LLC | Past | Accepting new patients | |
| University of Arkansas for Medical Sciences | Past |
Accepting new patients | |
| University of Arkansas for Medical Sciences | Past |
Accepting new patients |
Locations
200 S Hazel Dell Way
Ste 210
Canby, OR 97013
Phone (503) 263-9550
810 12th St
Hood River, OR 97031
Phone (541) 386-3911
1111 Crater Lake Ave
Medford, OR 97504
Phone (541) 732-5250
1001 N Providence Dr
Newberg, OR 97132
Phone (503) 216-1538
1500 Division St
Oregon City, OR 97045
Phone (503) 646-1631
10150 SE 32nd Ave
Portland, OR 97222
Phone (503) 215-4202
4805 NE Glisan St
Portland, OR 97213
Phone (503) 215-1111
9205 SW Barnes Rd
Portland, OR 97225
Phone (503) 216-1234
725 S Wahanna Rd
Seaside, OR 97138
Phone (503) 717-7000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Blood Banking & Transfusion Medicine Physician | 207ZB0001X | MD202871 | OR | |
| Blood Banking & Transfusion Medicine Physician | 207ZB0001X | C-7459 | AR | |
| Clinical Pathology/Laboratory Medicine Physician | 207ZP0105X | C-7459 | AR | |
| Clinical Pathology Physician | 207ZC0006X | MD202871 | OR | Yes |
Addresses
Primary practice location
4805 NE Glisan St
Portland, OR 97213-2933
Mailing address
PO Box 3395
Portland, OR 97208-3395
Phone (503) 215-6023
Other practice location 1
800 Marshall St # 653
Little Rock, AR 72202-3510
Phone (501) 364-1100
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 152157001 | Medicaid | AR |
Other providers in Portland, OR
- Suzanne Black
- Tanya L Black
- Tyler Whitman Black
- Walker Black
- Whitney Black
- Blackbird Natural Health, LLC
- Cody Blackburn
- Matthew Blackburn
- Susan Jean Blacker
- Brittany Blackford
All providers in Portland, OR · Clinical Pathology Physician in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 15, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.