Individual provider Active NPI

Sage Nottage Saxton, PSYD

  • Clinical Psychologist
  • Portland, OR
National Provider Identifier
1902811409
Registry record updated Mar 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
1601 Issued in OR
Practice address
707 SW Gaines St
Portland, OR 97239-2901
Phone
(503) 494-2672
NPI assigned
Jul 31, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 1601 OR Primary

Addresses

Primary practice location

707 SW Gaines St
Portland, OR 97239-2901

Mailing address

707 SW Gaines Street
Portland, OR 97239

Other identifiers 1

IdentifierTypeStateIssuer
275487MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041022000531 OR Practitioner - Clinical Psychologist 0941261903 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1601ORMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
University Professional Services CurrentSince May 16, 2010 Accepting new patients
University Professional Services Current Accepting new patients
University Professional Services CurrentSince May 16, 2010 Accepting new patients

Locations

15700 SW Greystone Ct
Beaverton, OR 97006
Phone (503) 203-1000

707 SW Gaines St
Portland, OR 97239
Phone (503) 492-2709

Interoperability endpoints

  • Direct secure messaging: ssaxton18943@direct.ohsu.edu

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1205971200000",
    "number": "1902811409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "707 SW GAINES STREET",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "707 SW GAINES ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972392901",
            "telephone_number": "503-494-2672"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAXTON",
        "first_name": "SAGE",
        "middle_name": "NOTTAGE",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-31",
        "last_updated": "2008-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "OR",
            "license": "1601",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "275487",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.