Individual provider Active NPI

David Morris Segouia Grunkemeier, MD

  • Gastroenterology Physician
  • Portland, OR
National Provider Identifier
1972542090
Registry record updated Nov 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
MD23842 Issued in OR
Practice address
9701 SW Barnes Rd
Suite #300
Portland, OR 97225-6589
Phone
(503) 297-8081
Fax
(503) 292-6601
NPI assigned
Jun 5, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X MD23842 OR Primary

Addresses

Primary practice location

9701 SW Barnes Rd
Suite #300
Portland, OR 97225-6589

Mailing address

541 NE 20TH Ave Ste 225
Portland, OR 97232-2895
Phone (503) 963-2801

Other identifiers 2

IdentifierTypeStateIssuer
006116MedicaidOR
8402478MedicaidWA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address cc_otoc_gastro_west_front_desk_pool12223293@oc.providencedirect.org The Oregon Clinic PC

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: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070912000820 OR Practitioner - GastroenterologyPractitioner - Internal Medicine 1951303544 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
GastroenterologyAlso: Internal Medicine
Education
Un of California, Irvine, College of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
The Oregon Clinic, PCGroup PAC ID 2860390408, 353 clinicians

Practice addresses (Care Compare)

9701 SW Barnes
Suite 300
Portland, OR 97225-6689
Phone (503) 297-8081

Hospital & facility affiliations

  • Providence St Vincent Medical Center Hospital, Portland, OR, CCN 380004
  • Adventist Health Tillamook Hospital, Tillamook, OR, CCN 381317
  • Providence Portland Medical Center Hospital, Portland, OR, CCN 380061

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy63
Upper gastrointestinal (GI) endoscopy for acid reflux41

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
The Oregon Clinic, PC CurrentSince Mar 31, 2008 Accepting new patients
The Oregon Clinic PC Gastroenterology CurrentSince Mar 31, 2008 Accepting new patients

Locations

847 NE 19th Ave
Ste 300
Portland, OR 97232

5050 NE Hoyt St
Ste 655
Portland, OR 97213
Phone (503) 239-6673

541 NE 20th Ave
Ste 225
Portland, OR 97232
Phone (503) 963-2801

9701 SW Barnes Rd
Ste 300
Portland, OR 97225
Phone (503) 297-8081

Interoperability endpoints

  • Direct secure messaging: dgrunkemeier101560@oc.providencedirect.org

Organizations & group practices 2

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 7

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

NPI Registry JSON

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

{
    "created_epoch": "1149465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731888000000",
    "number": "1972542090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "541 NE 20TH AVE STE 225",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972322895",
            "telephone_number": "503-963-2801",
            "fax_number": "503-963-2825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9701 SW BARNES RD",
            "address_2": "SUITE #300",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972256589",
            "telephone_number": "503-297-8081",
            "fax_number": "503-292-6601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRUNKEMEIER",
        "first_name": "DAVID",
        "middle_name": "MORRIS SEGOUIA",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-05",
        "last_updated": "2024-11-18",
        "certification_date": "2024-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "OR",
            "license": "MD23842",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "006116",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8402478",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cc_otoc_gastro_west_front_desk_pool12223293@oc.providencedirect.org",
            "affiliation": "Y",
            "affiliationName": "The Oregon Clinic PC",
            "address_1": "9701 SW Barnes Rd",
            "address_2": "Suite #300",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972256589",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.