NPIMap

Individual provider Active NPI

Joshua Paul Nickerson, M.D.

  • Diagnostic Radiology Physician
  • Portland, OR
National Provider Identifier
1932261906
Registry record updated Jun 13, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
MD186403 Issued in OR
Practice address
3181 SW Sam Jackson Park Rd
Portland, OR 97239
Phone
(503) 418-0990
Fax
(503) 494-4982
NPI assigned
Dec 15, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neuroradiology Physician 2085N0700X MD186403 OR
Diagnostic Radiology Physician 2085R0202X MD186403 OR Primary

Addresses

Primary practice location

3181 SW Sam Jackson Park Rd
Portland, OR 97239

Mailing address

3181 SW Sam Jackson Park Rd
Portland, OR 97239-3011
Phone (503) 418-0990

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, PA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20180516000826 OR Practitioner - Diagnostic Radiology 7113198524 Reassigns benefits to 4 organizations
I20191219000303 PA Practitioner - Diagnostic Radiology 7113198524 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Loma Linda University School of Medicine, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Geisinger-HM Joint Venture LLCGroup PAC ID 1355676370, shared by 5 NPIs, 426 clinicians
Geisinger ClinicGroup PAC ID 5395657001, shared by 7 NPIs, 3,432 clinicians
University Professional ServicesGroup PAC ID 4880760107, 1,683 clinicians

Practice addresses (Care Compare)

Lake Oswego, OR 97034
Phone (570) 271-6144

100 N Academy Ave
Danville, PA 17822-9800
Phone (570) 271-6211

255 Route 220 Hwy
Muncy, PA 17756-7569
Phone (570) 308-2600

51377 SW Old Portland Rd
Scappoose, OR 97056-4023
Phone (503) 418-4222

Hospital & facility affiliations

  • Ohsu Hospital and Clinics Hospital, Portland, OR, CCN 380009
  • Geisinger Medical Center Hospital, Danville, PA, CCN 390006
  • Geisinger Wyoming Valley Medical Center Hospital, Wilkes Barre, PA, CCN 390270
  • Geisinger-Bloomsburg Hospital Hospital, Bloomsburg, PA, CCN 390003
  • Geisinger-Lewistown Hospital Hospital, Lewistown, PA, CCN 390048

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD186403ORMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Geisinger Clinic Diagnostic Radiology CurrentSince Jan 20, 2020 Accepting new patients
University Professional Services Current Accepting new patients
Geisinger-HM Joint Venture, LLC Diagnostic Radiology Current Accepting new patients
Ohsu Outpatient Clinical Services LLC CurrentSince Nov 22, 2024 Accepting new patients
Geisinger Clinic Diagnostic Radiology CurrentSince Jan 20, 2020 Accepting new patients
Geisinger-HM Joint Venture, LLC Current Accepting new patients
Geisinger Clinic Current Accepting new patients
Geisinger-HM Joint Venture, LLC CurrentSince Jan 10, 2022 Accepting new patients
Tuality Medical Group LLC CurrentSince Nov 30, 2022 Accepting new patients
Tuality Medical Group LLC CurrentSince Nov 30, 2022 Accepting new patients
University Professional Services CurrentSince Jul 1, 2018 Accepting new patients
University Professional Services CurrentSince Jul 1, 2018 Accepting new patients

Locations

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

1501 NE Medical Center Dr
Bend, OR 97701
Phone (541) 317-4354

335 SE 8th Ave
Hillsboro, OR 97123
Phone (503) 681-1111

3181 SW Sam Jackson Park Rd
Portland, OR 97239
Phone (503) 494-5674

51377 SW Old Portland Rd
Scappoose, OR 97056
Phone (503) 418-4222

100 N Academy Ave
Danville, PA 17822

10 Choate Cir
Montoursville, PA 17754
Phone (570) 368-5566

255 Route 220 Hwy
Muncy, PA 17756
Phone (570) 308-2600

Interoperability endpoints

  • Direct secure messaging: jnickerson107252@direct.ohsu.edu

Organizations & group practices 12

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.

Hospital & facility affiliations 58

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 58

NPI Registry JSON

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

{
    "created_epoch": "1166140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528848000000",
    "number": "1932261906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3181 SW SAM JACKSON PARK RD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972393011",
            "telephone_number": "503-418-0990",
            "fax_number": "503-494-4982"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3181 SW SAM JACKSON PARK RD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97239",
            "telephone_number": "503-418-0990",
            "fax_number": "503-494-4982"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICKERSON",
        "first_name": "JOSHUA",
        "middle_name": "PAUL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-15",
        "last_updated": "2018-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085N0700X",
            "taxonomy_group": "",
            "desc": "Radiology, Neuroradiology",
            "state": "OR",
            "license": "MD186403",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "OR",
            "license": "MD186403",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.