Active NPI
Juan Carlos Gonzalez-Vitale, M.D.
- Anatomic Pathology & Clinical Pathology Physician
- Portland, OR
National Provider Identifier
1942348263
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician
- License
- MD16262
- Practice address
- 2801 N Gantenbein Ave
Portland, OR 97227-1623 - Phone
- (503) 413-4813
- Fax
- (503) 413-2982
- NPI assigned
- Feb 1, 2007
- Last updated
- May 7, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | MD16262 | OR | Primary |
Addresses
Primary practice location
2801 N Gantenbein Ave
Portland, OR 97227-1623
Mailing address
2801 N Gantenbein Ave
Portland, OR 97227-1623
Phone (503) 413-4813
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0134819 | Medicaid | OR | |
| 036629 | Other | OREGON WELFARE | |
| 036629 | Medicaid | OR |
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cascade Cytology Reference | Anatomic Pathology & Clinical Pathology | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Anatomic Pathology & Clinical Pathology Physician
- Portland, OR
- NPI 1871637371
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170288000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1241654400000",
"number": "1942348263",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2801 N GANTENBEIN AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972271623",
"telephone_number": "503-413-4813",
"fax_number": "503-413-2982"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2801 N GANTENBEIN AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972271623",
"telephone_number": "503-413-4813",
"fax_number": "503-413-2982"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GONZALEZ-VITALE",
"first_name": "JUAN",
"middle_name": "CARLOS",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-01",
"last_updated": "2009-05-07",
"status": "A"
},
"taxonomies": [
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "OR",
"license": "MD16262",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0134819",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OREGON WELFARE",
"identifier": "036629",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036629",
"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 May 7, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.