Active NPI
James Robert Thayer, MD
- Internal Medicine Physician
- Portland, OR
National Provider Identifier
1972551976
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- MD13684
- Practice address
- 426 SW Stark St
5TH Floor
Portland, OR 97204-2347 - Phone
- (503) 988-5140
- Fax
- (503) 988-5180
- NPI assigned
- May 4, 2006
- 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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | MD13684 | OR | Primary |
Addresses
Primary practice location
426 SW Stark St
5TH Floor
Portland, OR 97204-2347
Mailing address
421 SW Oak St
Suite 210
Portland, OR 97204-1817
Phone (503) 988-3663
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 105007 | Medicaid | OR | |
| 500628019 | 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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13684 | OR | MD | Specialist |
| MD13684 | OR | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Multnomah County | Past | Accepting new patients | |
| Multnomah County | Past | Accepting new patients |
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.
-
- Federally Qualified Health Center (FQHC)
- Portland, OR
- NPI 1336287416
-
- Federally Qualified Health Center (FQHC)
- Portland, OR
- NPI 1609914787
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146700800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1377648000000",
"number": "1972551976",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "421 SW OAK ST",
"address_2": "SUITE 210",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972041817",
"telephone_number": "503-988-3663",
"fax_number": "503-988-4098"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "426 SW STARK ST",
"address_2": "5TH FLOOR",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972042347",
"telephone_number": "503-988-5140",
"fax_number": "503-988-5180"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THAYER",
"first_name": "JAMES",
"middle_name": "ROBERT",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-04",
"last_updated": "2013-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "OR",
"license": "MD13684",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "105007",
"state": "OR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "500628019",
"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 Aug 28, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.