Individual provider Active NPI

Heather Anne Wilson, C.N.M.

  • Advanced Practice Midwife
  • Portland, OR
National Provider Identifier
1962649848
Registry record updated Mar 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Advanced Practice MidwifeTaxonomy code 367A00000X
License
201391420NP-PP Issued in OR
Practice address
2928 SE Hawthorne Blvd
Suite 107
Portland, OR 97214-4147
Phone
(503) 652-8076
Fax
(503) 922-0080
NPI assigned
Jan 14, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Midwife 176B00000X
Advanced Practice Midwife 367A00000X 201391420NP-PP OR Primary

Addresses

Primary practice location

2928 SE Hawthorne Blvd
Suite 107
Portland, OR 97214-4147

Mailing address

4110 SE Hawthorne Blvd
PMB 267
Portland, OR 97214-5246
Phone (503) 652-8076

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address hwilson580444@oc.providencedirect.org

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
I20160613001255 OR Practitioner - Certified Nurse Midwife (CNM) 2365732831 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Midwife

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services - Oregon CurrentSince May 13, 2016 Accepting new patients
Providence Health & Services Oregon Current Accepting new patients
Providence Health & Services - Oregon Current Accepting new patients
Providence Health & Services - Oregon CurrentSince May 13, 2016 Accepting new patients
Providence Health & Services - Oregon CurrentSince May 13, 2016 Accepting new patients
Providence Health & Services Oregon CurrentSince Apr 25, 2016 Accepting new patients
Providence Health & Services Oregon CurrentSince May 13, 2016 Accepting new patients
Providence Health & Services Oregon CurrentSince Apr 25, 2016 Accepting new patients

Locations

9290 SE Sunnybrook Blvd
Ste 210
Clackamas, OR 97015
Phone (503) 216-7960

9205 SW Barnes Rd
Portland, OR 97225
Phone (503) 216-1234

4805 NE Glisan St
Portland, OR 97213
Phone (503) 215-1111

545 NE 47th Ave
Ste 102
Portland, OR 97213
Phone (503) 215-6262

9135 SW Barnes Rd
Ste 761
Portland, OR 97225
Phone (503) 216-2602

5050 NE Hoyt St
Ste 454
Portland, OR 97213
Phone (503) 215-6405

Organizations & group practices 8

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": "1231891200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616630400000",
    "number": "1962649848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4110 SE HAWTHORNE BLVD",
            "address_2": "PMB 267",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972145246",
            "telephone_number": "503-652-8076",
            "fax_number": "503-922-0080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2928 SE HAWTHORNE BLVD",
            "address_2": "SUITE 107",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972144147",
            "telephone_number": "503-652-8076",
            "fax_number": "503-922-0080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "HEATHER",
        "middle_name": "ANNE",
        "name_prefix": "Ms.",
        "credential": "C.N.M.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-01-14",
        "last_updated": "2021-03-25",
        "certification_date": "2021-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "176B00000X",
            "taxonomy_group": "",
            "desc": "Midwife",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "OR",
            "license": "201391420NP-PP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "hwilson580444@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "545 NE 47th Ave Ste 102",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972132237",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.