Active NPI
Mark S. Yerby, MD
- Specialist
- Portland, OR
National Provider Identifier
1891960860
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- MD10835
- Practice address
- 830 NE 47TH Ave
Portland, OR 97213-2212 - Phone
- (503) 978-0178
- Fax
- (503) 286-7939
- NPI assigned
- Apr 29, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | MD10835 | OR | Primary |
| Vascular Neurology Physician | 2084V0102X | MD10835 | OR |
Addresses
Primary practice location
830 NE 47TH Ave
Portland, OR 97213-2212
Mailing address
8316 N Lombard St
PMB 324
Portland, OR 97203-3727
Phone (503) 978-0178
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 060160 | Medicaid | OR | |
| 1170059 | Other | WA | WA MEDICAID |
| 0000BJBPV | Other | OR | MEDICARE |
| 099529000 | Other | OR | BLUE CROSS |
| K72601 | Other | OR | PACIFICSOURCE |
| R0000BJBPV | Other | OR | GROUP MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD10835 | OR | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1209427200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1456704000000",
"number": "1891960860",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8316 N LOMBARD ST",
"address_2": "PMB 324",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972033727",
"telephone_number": "503-978-0178",
"fax_number": "503-286-7939"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "830 NE 47TH AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972132212",
"telephone_number": "503-978-0178",
"fax_number": "503-286-7939"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YERBY",
"first_name": "MARK",
"middle_name": "S.",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-04-29",
"last_updated": "2016-02-29",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "OR",
"license": "MD10835",
"primary": true
},
{
"code": "2084V0102X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Vascular Neurology",
"state": "OR",
"license": "MD10835",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "060160",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WA MEDICAID",
"identifier": "1170059",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE",
"identifier": "0000BJBPV",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "099529000",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PACIFICSOURCE",
"identifier": "K72601",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GROUP MEDICARE",
"identifier": "R0000BJBPV",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.