NPIMap

Providence Health & Services Oregon

Organization Active NPI Internal Medicine Physician · Oregon City, OR

NPI 1992138309 · NPPES record last updated Jul 4, 2025

Key facts

NPI
1992138309
Entity type
Organization (NPI type 2)
Primary specialty
Internal Medicine Physician 207R00000X
Legal business name
PROVIDENCE HEALTH & SERVICES OREGON
Practice address
1511 Division St Ste 101
Oregon City, OR 97045-1589
Phone
(503) 722-3705
Fax
(503) 722-3750
NPI assigned
Aug 21, 2013
Organization subpart
No

Authorized official

Name
Donald Wayne Anderson Jr.
Title
Asst Secretary for Enrollments
Phone
(425) 358-9786

Corporate family (same tax ID) 44

Organizations that report the same tax identification number in the National Provider Directory.

View all 44

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Enrolled in OR

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20031106000652 OR Part B Supplier - Clinic/Group Practice 0648183608 Receives reassigned benefits from 1,658 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

Tax ID family
Scholls Medical Group (45 organizations share this tax ID)

Locations

9135 SW Barnes Rd
Ste 763
Portland, OR 97225
Phone (503) 216-6050

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician
Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP		 207R00000X Yes
Child & Adolescent Psychiatry Physician
Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP		 2084P0804X
Adolescent and Children Mental Health Clinic/Center 261QM0855X

Addresses

Primary practice location

1511 Division St Ste 101
Oregon City, OR 97045-1589

Mailing address

PO Box 31001 - 4180
Pasadena, CA 91110-4180

Other names

  • PROVIDENCE MEDICAL GROUP Doing business as
  • Providence Willamette Falls Child Adolescent Outpatient Psychiatry Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 4, 2025.

{
    "created_epoch": "1377043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1751587200000",
    "number": "1992138309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31001 - 4180",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911104180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1511 DIVISION ST STE 101",
            "city": "OREGON CITY",
            "state": "OR",
            "postal_code": "970451589",
            "telephone_number": "503-722-3705",
            "fax_number": "503-722-3750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH & SERVICES OREGON",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-21",
        "last_updated": "2025-07-04",
        "certification_date": "2025-07-04",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "ASST SECRETARY FOR ENROLLMENTS",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PROVIDENCE MEDICAL GROUP",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Providence Willamette Falls Child Adolescent Outpatient Psychiatry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Providence Willamette Falls Child Adolescent Outpatient Psychiatry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Oregon City, OR

All providers in Oregon City, OR · Internal Medicine Physician in Oregon

Sources for this page

Verify at the official NPI Registry.