South Tabor Family Physicians

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

262417 Issued in OR

Legal business name

SOUTH TABOR FAMILY PHYSICIANS

Practice address

10803 SE Cherry Blossom Dr
Portland, OR 97216-3107

Phone

(503) 261-7200

Fax

(503) 261-7249

NPI assigned

Jun 19, 2006

Last updated

Oct 3, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Londa Everett

Title

Administrator

Phone

(503) 261-7200

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Sarah Katherine Morgan

  • Family Nurse Practitioner
  • Portland, OR
  • NPI 1629786678
  Medicare reassignment Care Compare group NPD
• William Bradford Bronec, M.D.

  • Family Medicine Physician
  • Portland, OR
  • NPI 1346530573
  Medicare reassignment Care Compare group
• Stephanie Robin Casey

  • Family Medicine Physician
  • Portland, OR
  • NPI 1023399367
  Medicare reassignment Care Compare group
• Jeana M Crover, M.D.

  • Family Medicine Physician
  • Portland, OR
  • NPI 1215963707
  Medicare reassignment Care Compare group
• Mario Casey Pacheco, MD

  • Family Medicine Physician
  • Portland, OR
  • NPI 1851979348
  Medicare reassignment Care Compare group
• Ainsley Grace Pate, PA-C

  • Physician Assistant
  • Portland, OR
  • NPI 1568182756
  Medicare reassignment Care Compare group
• Kayce A Spear, MD

  • Family Medicine Physician
  • Portland, OR
  • NPI 1437513835
  Medicare reassignment Care Compare group
• Jennifer Marie Stager, BS, MMS, PA-C

  • Physician Assistant
  • Portland, OR
  • NPI 1124210430
  Medicare reassignment Care Compare group
• Rhonda Durant, FNP

  • Family Nurse Practitioner
  • Portland, OR
  • NPI 1639105117
  Medicare reassignment
• Shefaa George, M.D.

  • Family Medicine Physician
  • Portland, OR
  • NPI 1508067075
  Medicare reassignment
• Megan Huang, PA

  • Physician Assistant
  • Portland, OR
  • NPI 1417223629
  Medicare reassignment
• Jeremiah Ben Knapp, M.D.

  • Family Medicine Physician
  • Tigard, OR
  • NPI 1922414721
  Medicare reassignment

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

{
    "created_epoch": "1150675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349222400000",
    "number": "1982649299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10803 SE CHERRY BLOSSOM DR",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972163107",
            "telephone_number": "503-261-7200",
            "fax_number": "503-261-7249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10803 SE CHERRY BLOSSOM DR",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972163107",
            "telephone_number": "503-261-7200",
            "fax_number": "503-261-7249"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH TABOR FAMILY PHYSICIANS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-19",
        "last_updated": "2012-10-03",
        "status": "A",
        "authorized_official_last_name": "EVERETT",
        "authorized_official_first_name": "LONDA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "503-261-7200"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "OR",
            "license": "262417",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sound Oxygen Service LLC (AdaptHealth)
• Sound Pain Alliance (Black Stone Health)
• Courtney Sound, MSW, CSWA
• Source Integrative Medicine LLC
• Sourcing Vitality, Inc. (The North Portland Wellness Center)
• South Waterfront Eye Care Inc.
• Joyce Southall, RN
• Rebecca Southard
• Jessica Southavilay Jackson, DC, LMT
• Southeast Dental PC

• Clinic/Center in Portland, OR
• Providers in Portland, OR by specialty
• Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.