| Providence Express Care | |
|
1025 Nw 14th Ave Portland OR 97209-2705 | |
| (888) 327-3312 | |
| Not Available |
| Full Name | Providence Express Care |
|---|---|
| Speciality | General Practice |
| Location | 1025 Nw 14th Ave, Portland, Oregon |
| Authorized Official Name and Position | Donald Wayne Anderson (ASSISTANT SECRETARY OF ENROLLMENTS) |
| Authorized Official Contact | 4253589786 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Express Care Po Box 3229 Portland OR 97208-3229 Ph: (888) 227-3312 | Providence Express Care 1025 Nw 14th Ave Portland OR 97209-2705 Ph: (888) 327-3312 |
| NPI Number | 1205499126 |
|---|---|
| Provider Enumeration Date | 04/16/2019 |
| Last Update Date | 06/03/2025 |
| Certification Date | 06/03/2025 |
| Medicare PECOS PAC ID | 1254768732 |
|---|---|
| Medicare Enrollment ID | O20200221001693 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205499126 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | () | Primary |
| 261Q00000X | Clinic/center | () | Secondary |
| Provider Name | Richard G Edison |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1710096458 PECOS PAC ID: 2062406481 Enrollment ID: I20040409000127 |
| Provider Name | John a Rogers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649371113 PECOS PAC ID: 2466480421 Enrollment ID: I20050801000229 |
| Provider Name | Desiree G Ang |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780667568 PECOS PAC ID: 1456355320 Enrollment ID: I20060907000156 |
| Provider Name | Bella Orbino |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710199427 PECOS PAC ID: 4082713946 Enrollment ID: I20070619000377 |
| Provider Name | Saubia Saeed |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1235315466 PECOS PAC ID: 8224109863 Enrollment ID: I20080625000367 |
| Provider Name | Calista Comstock |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1720240401 PECOS PAC ID: 8729156658 Enrollment ID: I20081006000440 |
| Provider Name | Tobias M Lopez |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1760736177 PECOS PAC ID: 8921250556 Enrollment ID: I20121206000220 |
| Provider Name | Karla Rivera |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1437570280 PECOS PAC ID: 3274755947 Enrollment ID: I20141112002468 |
| Provider Name | Ashley Wilkinson |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1821479049 PECOS PAC ID: 2860705373 Enrollment ID: I20150713002036 |
| Provider Name | Miriam Carla Sorensen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376914879 PECOS PAC ID: 3678874898 Enrollment ID: I20151214000272 |
| Provider Name | Marianna Baghdasaryan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164695102 PECOS PAC ID: 9032417860 Enrollment ID: I20160412001651 |
| Provider Name | Robyn Elizabeth Nash |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1043614167 PECOS PAC ID: 0244540359 Enrollment ID: I20171218003117 |
| Provider Name | Christopher Swanson |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1750802393 PECOS PAC ID: 0749540342 Enrollment ID: I20180130001509 |
| Provider Name | Huyen Ngoc Sanders |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1104346899 PECOS PAC ID: 3072873959 Enrollment ID: I20180214002697 |
| Provider Name | Bonnie E Hinckley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649481896 PECOS PAC ID: 6305913468 Enrollment ID: I20181031000684 |
| Provider Name | Trung P Chung |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1720489297 PECOS PAC ID: 8224347802 Enrollment ID: I20181120003114 |
| Provider Name | Christine T De Cejka |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1164980108 PECOS PAC ID: 3375876345 Enrollment ID: I20190605003145 |
| Provider Name | Brian J Rouse |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1932570801 PECOS PAC ID: 2163717976 Enrollment ID: I20191122001642 |
| Provider Name | Brandy Bump Zerby |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1538538327 PECOS PAC ID: 6800199951 Enrollment ID: I20191126001026 |
| Provider Name | Steven Beardsley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457903239 PECOS PAC ID: 7416389457 Enrollment ID: I20200224001052 |
| Provider Name | Eric L Foote |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1245481761 PECOS PAC ID: 1355535329 Enrollment ID: I20200422002817 |
| Provider Name | Olubanke Babalola |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013329002 PECOS PAC ID: 9133345275 Enrollment ID: I20200605001926 |
| Provider Name | Arsen Shrestha |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1770101636 PECOS PAC ID: 0143630392 Enrollment ID: I20201029001886 |
| Provider Name | Thomas Robert Stassen |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1356694350 PECOS PAC ID: 3870745870 Enrollment ID: I20210428001835 |
| Provider Name | Kimberly Lindquist |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1427728906 PECOS PAC ID: 2961890108 Enrollment ID: I20211021000450 |
| Provider Name | Jonathan Hale |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003560459 PECOS PAC ID: 7315263209 Enrollment ID: I20220805000638 |
| Provider Name | Christopher Flom |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891823753 PECOS PAC ID: 5597098608 Enrollment ID: I20230420001595 |
| Provider Name | Anitha Joseph |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992496335 PECOS PAC ID: 9133587785 Enrollment ID: I20230929000957 |
| Provider Name | Ann M Rarey |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1700504842 PECOS PAC ID: 3375993058 Enrollment ID: I20231220003824 |
| Provider Name | Thien-huong Van |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1164072286 PECOS PAC ID: 8022426444 Enrollment ID: I20240311001033 |
| Provider Name | Daniel Graham |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1740830637 PECOS PAC ID: 4183023716 Enrollment ID: I20241029002345 |
| Provider Name | Matthew Mccowan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821694977 PECOS PAC ID: 9830507037 Enrollment ID: I20241122000368 |
| Provider Name | Jennipher K Vallery |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1649562679 PECOS PAC ID: 7810167335 Enrollment ID: I20241230003060 |
| Provider Name | Zachary Miller |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1861984239 PECOS PAC ID: 9830449586 Enrollment ID: I20250226002925 |
| Provider Name | Hannah Kinghorn |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1932584125 PECOS PAC ID: 0042511289 Enrollment ID: I20250310001383 |
| Provider Name | Madelene Pena |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1932883188 PECOS PAC ID: 0244767895 Enrollment ID: I20250402001184 |
| Provider Name | Anne Heiner |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1932472461 PECOS PAC ID: 4981905510 Enrollment ID: I20250502002596 |
| Provider Name | Rafael Carnet |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467139642 PECOS PAC ID: 2860932456 Enrollment ID: I20250627001105 |
| Provider Name | Danae R Vermulm |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336991447 PECOS PAC ID: 0345776738 Enrollment ID: I20250707001037 |
| Provider Name | Adriana Rachelle Katz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336968361 PECOS PAC ID: 1355830597 Enrollment ID: I20251029000828 |
| Provider Name | Stephanie Alteen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043006620 PECOS PAC ID: 4284129156 Enrollment ID: I20251218000469 |
| Provider Name | Callie Jan Pruitt Mills |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1871159954 PECOS PAC ID: 9931515335 Enrollment ID: I20260311001982 |
| Provider Name | Thomas Edward Freels |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841145794 PECOS PAC ID: 3779067269 Enrollment ID: I20260323003062 |
Woodstock Family Medicine LLC Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5536 Se Woodstock Blvd, Portland, OR 97206 Phone: 503-236-1830 Fax: 503-236-1908 |
Internal Medicine Consultants, P.C. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 9585 Sw Washington Square Rd, Portland, OR 97223 Phone: 503-320-2121 Fax: 503-641-4158 |
The Wellness Center Pdx Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1359 Ne 35th Avenue, Portland, OR 97232 Phone: 503-389-5545 |
Providence Medical Group Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 5211 Ne Glisan St Bldg C, Portland, OR 97213 Phone: 503-215-6628 Fax: 503-215-6240 |
Interstate Medical Office West Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3325 N Interstate Ave, Portland, OR 97227 Phone: 800-813-2000 Fax: 503-286-6879 |
Jenna Halbert, ND LLC Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 333 Ne Russell St Ste 207, Portland, OR 97212 Phone: 503-482-8301 |