NPIMap

Individual provider Active NPI

Mark D. Reller, M.D.

  • Pediatric Cardiology Physician
  • Portland, OR
National Provider Identifier
1972548469
Registry record updated Nov 18, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Cardiology PhysicianTaxonomy code 2080P0202X
License
MD13950 Issued in OR
Practice address
707 SW Gaines St
CDRC-P
Portland, OR 97239-2901
Phone
(503) 494-2192
Fax
(503) 494-2824
NPI assigned
Jun 18, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X MD13950 OR
Pediatric Cardiology Physician 2080P0202X MD13950 OR Primary

Addresses

Primary practice location

707 SW Gaines St
CDRC-P
Portland, OR 97239-2901

Mailing address

707 SW Gaines St
CDRC-P
Portland, OR 97239-2901
Phone (503) 494-2192

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040709000292 OR Practitioner - Cardiovascular Disease (Cardiology) 2264410927 Reassigns benefits to 4 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD13950ORMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Asante CurrentSince Sep 2, 2012 Accepting new patients
Good Samaritan Hospital Corvallis CurrentSince Jan 16, 2019 Accepting new patients
Asante Three Rivers Medical Center, LLC CurrentSince Sep 2, 2012 Accepting new patients
Albany General Hospital CurrentSince Jan 16, 2019 Accepting new patients
Albany General Hospital Current Accepting new patients
Good Samaritan Hospital Corvallis CurrentSince Jan 16, 2019 Accepting new patients
Asante CurrentSince Sep 2, 2012 Accepting new patients
Albany General Hospital Pediatrics CurrentSince Jan 16, 2019 Accepting new patients
Firstcare Medical Foundation Pediatrics Past Accepting new patients

Locations

705 Elm St SW
Ste 200
Albany, OR 97321
Phone (541) 812-4850

3600 NW Samaritan Dr
Ste 227
Corvallis, OR 97330
Phone (541) 768-1261

2825 E Barnett Rd
Medford, OR 97504
Phone (541) 282-6770

Organizations & group practices 9

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": "1150588800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1321574400000",
    "number": "1972548469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "707 SW GAINES ST",
            "address_2": "CDRC-P",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972392901",
            "telephone_number": "503-494-2192",
            "fax_number": "503-494-2824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "707 SW GAINES ST",
            "address_2": "CDRC-P",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972392901",
            "telephone_number": "503-494-2192",
            "fax_number": "503-494-2824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RELLER",
        "first_name": "MARK",
        "middle_name": "D.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-18",
        "last_updated": "2011-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OR",
            "license": "MD13950",
            "primary": false
        },
        {
            "code": "2080P0202X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "OR",
            "license": "MD13950",
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Nov 18, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.