| Legacy Meridian Park Hospital | |
|
19300 Sw 65th Ave Tualatin OR 97062-7706 | |
| (503) 692-1212 | |
| Not Available |
| Full Name | Legacy Meridian Park Hospital |
|---|---|
| Speciality | General Acute Care Hospital |
| Location | 19300 Sw 65th Ave, Tualatin, Oregon |
| Authorized Official Name and Position | Sarah Jensen (INTERIM CFO) |
| Authorized Official Contact | 5034155145 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Legacy Meridian Park Hospital Po Box 4037 Portland OR 97208-4037 Ph: (503) 413-2017 | Legacy Meridian Park Hospital 19300 Sw 65th Ave Tualatin OR 97062-7706 Ph: (503) 692-1212 |
| NPI Number | 1184647620 |
|---|---|
| Provider Enumeration Date | 07/25/2006 |
| Last Update Date | 02/27/2018 |
| Medicare PECOS PAC ID | 5092609842 |
|---|---|
| Medicare Enrollment ID | O20040211001181 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184647620 | NPI | - | NPPES |
| HS691IP | Medicaid | AK | |
| XHSP30260 | Medicaid | CA | |
| XHSP40260 | Medicaid | CA | |
| 138008900 | Other | OR | REGENCE BLUE CROSS |
| 33766 | Medicaid | ID | |
| 3018504 | Medicaid | WA | |
| 122499 | Medicaid | OR | |
| HS691OP | Medicaid | AK | |
| 234454 | Medicaid | OR |
| Provider Name | Samuel S M Lau |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1811995087 PECOS PAC ID: 9931012226 Enrollment ID: I20031112000210 |
| Provider Name | John Andrew Kaufman |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1992711584 PECOS PAC ID: 0446152763 Enrollment ID: I20040126000497 |
| Provider Name | David S Peizner |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1245235233 PECOS PAC ID: 0042104051 Enrollment ID: I20040211000246 |
| Provider Name | Kevin G Semonsen |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1629010087 PECOS PAC ID: 7416859848 Enrollment ID: I20040216000696 |
| Provider Name | Daniel Urbach |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1952386377 PECOS PAC ID: 2769371012 Enrollment ID: I20040313000554 |
| Provider Name | Ramnik S Jhooty |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1548265457 PECOS PAC ID: 8628968971 Enrollment ID: I20040318001470 |
| Provider Name | Elizabeth R Sammond |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1437127347 PECOS PAC ID: 8820081334 Enrollment ID: I20040408000164 |
| Provider Name | Kenneth L Rhoads |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1912904103 PECOS PAC ID: 1456348150 Enrollment ID: I20040426001639 |
| Provider Name | Daniela B Samoil |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1891750329 PECOS PAC ID: 2567364631 Enrollment ID: I20040430000138 |
| Provider Name | Karen Joan Wesenberg |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1811980998 PECOS PAC ID: 0042209744 Enrollment ID: I20040508000015 |
| Provider Name | Eli A Rosenthal |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1356346399 PECOS PAC ID: 3274515853 Enrollment ID: I20040607000603 |
| Provider Name | Amanda S Gay |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1912937723 PECOS PAC ID: 0648239012 Enrollment ID: I20041011000265 |
| Provider Name | Benjamin L Brody |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1245243799 PECOS PAC ID: 7517925472 Enrollment ID: I20041222000662 |
| Provider Name | Kar Yee Wu |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1861418832 PECOS PAC ID: 0547201063 Enrollment ID: I20050516000292 |
| Provider Name | Andrew D Glass |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1437103223 PECOS PAC ID: 9537192083 Enrollment ID: I20050914001278 |
| Provider Name | Bradley H Evans |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1568464261 PECOS PAC ID: 6103724604 Enrollment ID: I20051020001106 |
| Provider Name | Pulla Reddy |
|---|---|
| Provider Type | Practitioner - Advanced Heart Failure And Transplant Cardiology |
| Provider Identifiers | NPI Number: 1437167962 PECOS PAC ID: 3870577497 Enrollment ID: I20051114000999 |
| Provider Name | Pompy Z Goswami |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1740216472 PECOS PAC ID: 0244251130 Enrollment ID: I20051207000416 |
| Provider Name | Michael P Jaczko |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1487647954 PECOS PAC ID: 8921029653 Enrollment ID: I20051209000360 |
| Provider Name | Srividya Venigalla |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1104887595 PECOS PAC ID: 4880617877 Enrollment ID: I20060104001026 |
| Provider Name | Peter Frederick Banitt |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1831194737 PECOS PAC ID: 2668488008 Enrollment ID: I20060222000726 |
| Provider Name | Naji M Hamdan |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1679570873 PECOS PAC ID: 2163438227 Enrollment ID: I20060227000362 |
| Provider Name | Manish Mehta |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1750310173 PECOS PAC ID: 8921002593 Enrollment ID: I20060913000261 |
| Provider Name | Jane E Schuster |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1619989431 PECOS PAC ID: 7517965387 Enrollment ID: I20061110000292 |
| Provider Name | Janet C West |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1447299284 PECOS PAC ID: 0143237628 Enrollment ID: I20070118000608 |
| Provider Name | Judith Angela Nigro |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1760566368 PECOS PAC ID: 7416955935 Enrollment ID: I20070126000242 |
| Provider Name | Janel R Guyette |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205990660 PECOS PAC ID: 7214994565 Enrollment ID: I20070327000380 |
| Provider Name | Vandy L Sherbin |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1083711857 PECOS PAC ID: 1052410644 Enrollment ID: I20070622000109 |
| Provider Name | Steven L Grund |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1851420863 PECOS PAC ID: 4385744606 Enrollment ID: I20070716000117 |
| Provider Name | Diana K Boss |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1023239407 PECOS PAC ID: 5597866269 Enrollment ID: I20070725000094 |
| Provider Name | Daniel S Isenbarger |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1780765941 PECOS PAC ID: 4284728528 Enrollment ID: I20070918000477 |
| Provider Name | Holly I Tse |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1912089947 PECOS PAC ID: 9234219304 Enrollment ID: I20071231000569 |
| Provider Name | Leslie Root |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1831167907 PECOS PAC ID: 2163591520 Enrollment ID: I20080527000577 |
| Provider Name | Catherine J Markin |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1285731059 PECOS PAC ID: 9032288402 Enrollment ID: I20080527000609 |
| Provider Name | Paula Gerber-gore |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1518156504 PECOS PAC ID: 0143392464 Enrollment ID: I20080702000197 |
| Provider Name | Robert F Quintos |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1750324653 PECOS PAC ID: 5890737886 Enrollment ID: I20080710000300 |
| Provider Name | John M Dempster |
|---|---|
| Provider Type | Practitioner - Other (physician) |
| Provider Identifiers | NPI Number: 1386854974 PECOS PAC ID: 8820161375 Enrollment ID: I20080717000209 |
| Provider Name | Jeffrey Martin Bluhm |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1730125022 PECOS PAC ID: 9133151525 Enrollment ID: I20080813000445 |
| Provider Name | Karl Nicholas Kaluza |
|---|---|
| Provider Type | Practitioner - Sports Medicine |
| Provider Identifiers | NPI Number: 1760431175 PECOS PAC ID: 2668433921 Enrollment ID: I20080925000480 |
| Provider Name | Gail A Moses |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1841259389 PECOS PAC ID: 5597774513 Enrollment ID: I20081010000101 |
| Provider Name | David R Peter |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1821189309 PECOS PAC ID: 1658457403 Enrollment ID: I20081229000630 |
| Provider Name | Carl Anthony Riddick |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1093751372 PECOS PAC ID: 8224060629 Enrollment ID: I20090120000501 |
| Provider Name | Rebecca G Hills |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1942259833 PECOS PAC ID: 6800950593 Enrollment ID: I20090123000528 |
| Provider Name | Reza Antoszewska |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770645251 PECOS PAC ID: 7618984634 Enrollment ID: I20090423000770 |
| Provider Name | Robert Dong Kim |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1780620096 PECOS PAC ID: 5597783738 Enrollment ID: I20090924000569 |
| Provider Name | Sandeep Garg |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1316942238 PECOS PAC ID: 5991874125 Enrollment ID: I20091222000746 |
| Provider Name | Shawn Timothy Patrick |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1699769786 PECOS PAC ID: 1254466733 Enrollment ID: I20100323000531 |
| Provider Name | David Edward Wu |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1063404739 PECOS PAC ID: 1658451299 Enrollment ID: I20100323000643 |
| Provider Name | Suzanne Migchelbrink |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1174592190 PECOS PAC ID: 7113053836 Enrollment ID: I20100331001058 |
| Provider Name | John Thomas Forsythe |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1134188386 PECOS PAC ID: 3173659802 Enrollment ID: I20100331001114 |
| Provider Name | Jay P Brown |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1306874037 PECOS PAC ID: 0446387716 Enrollment ID: I20100416000719 |
| Provider Name | Brian M Bedolla |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1649205808 PECOS PAC ID: 4880644004 Enrollment ID: I20100814000260 |
| Provider Name | Anne Juliana Lockman |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1871708529 PECOS PAC ID: 8224162094 Enrollment ID: I20100816000410 |
| Provider Name | Kelly F Scott |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1144294885 PECOS PAC ID: 5799819173 Enrollment ID: I20100820000603 |
| Provider Name | Tanell E Ogbeide |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609108687 PECOS PAC ID: 4284750126 Enrollment ID: I20100928001108 |
| Provider Name | Jocelyn F Camara |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1760454615 PECOS PAC ID: 0143232751 Enrollment ID: I20101019000343 |
| Provider Name | Kenneth L Martin |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1902875016 PECOS PAC ID: 2163615154 Enrollment ID: I20101022000524 |
| Provider Name | Samantha A Mckay |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1801087283 PECOS PAC ID: 1951594845 Enrollment ID: I20101023000328 |
| Provider Name | George A Anadiotis |
|---|---|
| Provider Type | Practitioner - Medical Genetics And Genomics |
| Provider Identifiers | NPI Number: 1992766695 PECOS PAC ID: 3476747171 Enrollment ID: I20101026001596 |
| Provider Name | Gwen Grewe |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1326014234 PECOS PAC ID: 2961696240 Enrollment ID: I20101101000210 |
| Provider Name | Curtis Mark Climer |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1538151857 PECOS PAC ID: 4082894340 Enrollment ID: I20110203001158 |
| Provider Name | Coral A Nash |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912142746 PECOS PAC ID: 2264598358 Enrollment ID: I20110404000621 |
| Provider Name | Eric L Pacini |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1043420086 PECOS PAC ID: 6002086139 Enrollment ID: I20110829000698 |
| Provider Name | Viktoriya D Monroe |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1649431693 PECOS PAC ID: 1153593363 Enrollment ID: I20111012000724 |
| Provider Name | Caroline A Motika |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1245359454 PECOS PAC ID: 6406029636 Enrollment ID: I20111102000785 |
| Provider Name | Warren I Okuns |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1134385461 PECOS PAC ID: 5698949717 Enrollment ID: I20111129000298 |
| Provider Name | Bethany M Higa |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1851605430 PECOS PAC ID: 0547436834 Enrollment ID: I20120109000714 |
| Provider Name | Joshua Alexander Gepner |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1174778328 PECOS PAC ID: 9335308873 Enrollment ID: I20120302000153 |
| Provider Name | Joseph Albert Amavisca |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1316178189 PECOS PAC ID: 9436314895 Enrollment ID: I20120710000304 |
| Provider Name | Juliette Lorraine Cutts |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1851548515 PECOS PAC ID: 4385817436 Enrollment ID: I20130222000288 |
| Provider Name | Cameron Ramsay |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1255455929 PECOS PAC ID: 8729133814 Enrollment ID: I20130521000647 |
| Provider Name | James Bordley V |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1346566981 PECOS PAC ID: 1759536543 Enrollment ID: I20130523000566 |
| Provider Name | Christopher L Fraley |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1821011693 PECOS PAC ID: 6608870845 Enrollment ID: I20130716000154 |
| Provider Name | Anong Y Burke |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1932205556 PECOS PAC ID: 6709962368 Enrollment ID: I20130730000577 |
| Provider Name | Erika Maria Moseson |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1790010387 PECOS PAC ID: 9133305337 Enrollment ID: I20130801000886 |
| Provider Name | Emmanuel Tavan |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1003007907 PECOS PAC ID: 8224283056 Enrollment ID: I20130820000325 |
| Provider Name | Jenny Nordeen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871789024 PECOS PAC ID: 2163614389 Enrollment ID: I20130918000607 |
| Provider Name | Colene I Andersen |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1710932421 PECOS PAC ID: 8426052663 Enrollment ID: I20130924000270 |
| Provider Name | Jody H Tate |
|---|---|
| Provider Type | Practitioner - Sleep Medicine |
| Provider Identifiers | NPI Number: 1740318815 PECOS PAC ID: 8123252442 Enrollment ID: I20130927000593 |
| Provider Name | Cara J Lutze |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1982920872 PECOS PAC ID: 6204060379 Enrollment ID: I20131002000559 |
| Provider Name | Laura Ostrom |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1528371382 PECOS PAC ID: 1850526955 Enrollment ID: I20131025001590 |
| Provider Name | Masahiro Horikawa |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1538587118 PECOS PAC ID: 9436374147 Enrollment ID: I20140711001578 |
| Provider Name | Brendan John Daly |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1275731226 PECOS PAC ID: 6406988187 Enrollment ID: I20140823000363 |
| Provider Name | Jenna M Donaldson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1053606137 PECOS PAC ID: 3678792066 Enrollment ID: I20140917001157 |
| Provider Name | Mary S Mckenzie |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1447417100 PECOS PAC ID: 6800027657 Enrollment ID: I20141204000680 |
| Provider Name | Alia Paquette |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1154612851 PECOS PAC ID: 4486979689 Enrollment ID: I20150210002420 |
| Provider Name | Azad John-salimi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1639499817 PECOS PAC ID: 0446576292 Enrollment ID: I20150313000995 |
| Provider Name | Allean C Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144540063 PECOS PAC ID: 8325164304 Enrollment ID: I20150417000893 |
| Provider Name | Judith Tamarah Marcus |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1437139011 PECOS PAC ID: 6103954771 Enrollment ID: I20150519000225 |
| Provider Name | Amish J Desai |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1134282932 PECOS PAC ID: 9537190756 Enrollment ID: I20150603003148 |
| Provider Name | Kenneth M Leclerc |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1760483754 PECOS PAC ID: 6507836814 Enrollment ID: I20150615002057 |
| Provider Name | Shao-hwa P Wei |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1205062361 PECOS PAC ID: 7517278146 Enrollment ID: I20150623001219 |
| Provider Name | Adama Diarra |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1306103338 PECOS PAC ID: 2466778766 Enrollment ID: I20150706002752 |
| Provider Name | Eric J Macevoy |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1912267816 PECOS PAC ID: 3072825926 Enrollment ID: I20150827000803 |
| Provider Name | Abigail Vautrain |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1710208921 PECOS PAC ID: 3173767019 Enrollment ID: I20150831002712 |
| Provider Name | Kelsey M Conklin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801255120 PECOS PAC ID: 0840589651 Enrollment ID: I20160518001305 |
| Provider Name | David H Delman |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1669764924 PECOS PAC ID: 4082833926 Enrollment ID: I20160831000741 |
| Provider Name | Anaise H Hines |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447561279 PECOS PAC ID: 8426244138 Enrollment ID: I20161115001277 |
| Provider Name | Megan Barckert |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649348160 PECOS PAC ID: 5193008977 Enrollment ID: I20170202001315 |
| Provider Name | Matthew D Champion |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1962778902 PECOS PAC ID: 9537477047 Enrollment ID: I20170522000791 |
| Provider Name | Laura E Anissian |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1194989244 PECOS PAC ID: 1557439767 Enrollment ID: I20170619001396 |
| Provider Name | Nikolaus A Kashey |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1538155775 PECOS PAC ID: 4183653389 Enrollment ID: I20170717003501 |
| Provider Name | Gurjeet Singh |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1780947937 PECOS PAC ID: 8224261763 Enrollment ID: I20170731001640 |
| Provider Name | Lawrence S Tremaine |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1447334032 PECOS PAC ID: 9133431760 Enrollment ID: I20170814002672 |
| Provider Name | Angela M Gibbs |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1487034484 PECOS PAC ID: 1951614304 Enrollment ID: I20170818002042 |
| Provider Name | Brandy Carpenter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033658539 PECOS PAC ID: 6608142500 Enrollment ID: I20171020000992 |
| Provider Name | Melissa L Keller |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1821453093 PECOS PAC ID: 5496017915 Enrollment ID: I20180321002479 |
| Provider Name | Elizabeth Alston |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205348539 PECOS PAC ID: 4981967726 Enrollment ID: I20180410000712 |
| Provider Name | Jennifer Maire |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1902293459 PECOS PAC ID: 6608124177 Enrollment ID: I20180731004208 |
| Provider Name | Rebecca L Corbett |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1912391830 PECOS PAC ID: 9032424171 Enrollment ID: I20180807001819 |
| Provider Name | Nii O Koney |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1649536301 PECOS PAC ID: 0345519252 Enrollment ID: I20180827003354 |
| Provider Name | Samuel W Bullick |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1386904662 PECOS PAC ID: 2860633286 Enrollment ID: I20181022002155 |
| Provider Name | Ricardo Sanchez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679048979 PECOS PAC ID: 3870838659 Enrollment ID: I20181226000597 |
| Provider Name | Melissa Renee Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437636065 PECOS PAC ID: 3971848623 Enrollment ID: I20181227001190 |
| Provider Name | Tara Marie Mcgarry |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1184975260 PECOS PAC ID: 3971856543 Enrollment ID: I20190110003432 |
| Provider Name | Miranda A Meng |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1336373950 PECOS PAC ID: 5991041840 Enrollment ID: I20190114001628 |
| Provider Name | Rychel Rae Cor |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1154563633 PECOS PAC ID: 2860730934 Enrollment ID: I20190214002899 |
| Provider Name | Marco R Valencia |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1487966107 PECOS PAC ID: 2365683968 Enrollment ID: I20190221001158 |
| Provider Name | Jessie Kha Trieu |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1891049128 PECOS PAC ID: 7911221023 Enrollment ID: I20190404002288 |
| Provider Name | Jeffrey Drood |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1558419770 PECOS PAC ID: 1456249481 Enrollment ID: I20190425002408 |
| Provider Name | Marc Michael Delrosario Lim |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1073956991 PECOS PAC ID: 3678823275 Enrollment ID: I20190710002453 |
| Provider Name | Teodora Nikolaeva Bochnakova |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1780020008 PECOS PAC ID: 7719242916 Enrollment ID: I20190711001872 |
| Provider Name | Steven Sears |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1275890675 PECOS PAC ID: 5496990921 Enrollment ID: I20190725003264 |
| Provider Name | Vivian Marie Suarez Gonzalez |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1801107388 PECOS PAC ID: 7618145830 Enrollment ID: I20190912002014 |
| Provider Name | Michelle Boudreau |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1346534864 PECOS PAC ID: 7416182480 Enrollment ID: I20190918000941 |
| Provider Name | Rebecca L Niemeyer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083895551 PECOS PAC ID: 4385714336 Enrollment ID: I20191002002788 |
| Provider Name | Nicholas J Abbott |
|---|---|
| Provider Type | Practitioner - Cardiac Electrophysiology |
| Provider Identifiers | NPI Number: 1124319330 PECOS PAC ID: 9335437813 Enrollment ID: I20200421001347 |
| Provider Name | Brian Jinwoo Park |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1376961896 PECOS PAC ID: 9335446830 Enrollment ID: I20200715002683 |
| Provider Name | Larissa M Brodsky |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1578090197 PECOS PAC ID: 8820366651 Enrollment ID: I20200813000104 |
| Provider Name | Christine Garrow |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407336787 PECOS PAC ID: 2961829551 Enrollment ID: I20200827001690 |
| Provider Name | Mehwish Farooqi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1750872214 PECOS PAC ID: 7416386685 Enrollment ID: I20200922000989 |
| Provider Name | James Boyd |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1720254204 PECOS PAC ID: 3476728908 Enrollment ID: I20201013002466 |
| Provider Name | Jamie Skreen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083140115 PECOS PAC ID: 6103197876 Enrollment ID: I20201106000573 |
| Provider Name | Mary Frances Lowdermilk |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1245453315 PECOS PAC ID: 5890982599 Enrollment ID: I20210120002091 |
| Provider Name | Mayank Agrawal |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1831308063 PECOS PAC ID: 5799816096 Enrollment ID: I20210218000928 |
| Provider Name | Emoniel Isakharov |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1649777863 PECOS PAC ID: 5294088241 Enrollment ID: I20210706002148 |
| Provider Name | Jennifer Hines |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1205274370 PECOS PAC ID: 0547486730 Enrollment ID: I20210709002595 |
| Provider Name | Tanay Patel |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1982929840 PECOS PAC ID: 9830481084 Enrollment ID: I20210818003977 |
| Provider Name | Daniel Hillman |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1528453180 PECOS PAC ID: 9537468244 Enrollment ID: I20210901003888 |
| Provider Name | Sidhartha O Tavri |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1851566269 PECOS PAC ID: 5698993236 Enrollment ID: I20210908004023 |
| Provider Name | Sierra Lamotte |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1427721869 PECOS PAC ID: 6709283120 Enrollment ID: I20210927002545 |
| Provider Name | Deepti G Singhvi |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1639411291 PECOS PAC ID: 9032408331 Enrollment ID: I20210928003530 |
| Provider Name | Ola Abd Lafi |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1356728042 PECOS PAC ID: 4587936620 Enrollment ID: I20211018000824 |
| Provider Name | Taylor C Myers |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1093100158 PECOS PAC ID: 7113232901 Enrollment ID: I20211019001253 |
| Provider Name | Keith B Quencer |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1760643290 PECOS PAC ID: 2264690841 Enrollment ID: I20211104002884 |
| Provider Name | Claire S Kaufman |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1356630073 PECOS PAC ID: 1456620665 Enrollment ID: I20211124000858 |
| Provider Name | Kelly Nicole Snow |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1710558721 PECOS PAC ID: 2961892047 Enrollment ID: I20211203001054 |
| Provider Name | Colby A. Richardson |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1558724799 PECOS PAC ID: 2567866973 Enrollment ID: I20211208003192 |
| Provider Name | Kristina Kalinova Lubliner |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1730776329 PECOS PAC ID: 3476943051 Enrollment ID: I20211214002751 |
| Provider Name | Ashley Ellsworth |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1558024679 PECOS PAC ID: 5193116796 Enrollment ID: I20211215000781 |
| Provider Name | Suzanne D Hughes |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1306266853 PECOS PAC ID: 0648576884 Enrollment ID: I20211222001415 |
| Provider Name | Joanne P Parker |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1962452433 PECOS PAC ID: 4587655527 Enrollment ID: I20220121002135 |
| Provider Name | Moses Chibuzo Azubuike |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1700232105 PECOS PAC ID: 8729353156 Enrollment ID: I20220314001929 |
| Provider Name | Abhi H Kapuria |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1730542812 PECOS PAC ID: 8820493935 Enrollment ID: I20220317002070 |
| Provider Name | Satinder Kaur Grewal |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1386085546 PECOS PAC ID: 7618229436 Enrollment ID: I20220404001864 |
| Provider Name | Elizabeth Neal |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1356455265 PECOS PAC ID: 1254354046 Enrollment ID: I20220412001892 |
| Provider Name | Edward P Cheng |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1417360587 PECOS PAC ID: 7113227844 Enrollment ID: I20220518001593 |
| Provider Name | Ryan D Meek |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1275923146 PECOS PAC ID: 6305110891 Enrollment ID: I20220526000072 |
| Provider Name | Aalap D Narichania |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1144665266 PECOS PAC ID: 3779712328 Enrollment ID: I20220629001673 |
| Provider Name | Tsyria S Tang |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1003376120 PECOS PAC ID: 7315273638 Enrollment ID: I20220712003123 |
| Provider Name | Leena Youssefian-halleran |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1376963959 PECOS PAC ID: 1759713548 Enrollment ID: I20220815003426 |
| Provider Name | Steven Gangloff |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1952756058 PECOS PAC ID: 4587951637 Enrollment ID: I20220826003015 |
| Provider Name | Joanne Tuyet Stowell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1639701063 PECOS PAC ID: 9032509468 Enrollment ID: I20220926002433 |
| Provider Name | Raymond D Fisher |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1245640515 PECOS PAC ID: 0749577450 Enrollment ID: I20221019003177 |
| Provider Name | Madhavi Murthy |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1144323619 PECOS PAC ID: 5890947154 Enrollment ID: I20221221003161 |
| Provider Name | Andrew J Bitney |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154815983 PECOS PAC ID: 6901201516 Enrollment ID: I20221227002505 |
| Provider Name | Jennifer L Stone |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1003010307 PECOS PAC ID: 6305993254 Enrollment ID: I20230222000162 |
| Provider Name | Natalie Athena Teegarden |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1144928219 PECOS PAC ID: 3577937895 Enrollment ID: I20230328000320 |
| Provider Name | Mehwish Farooqi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1750872214 PECOS PAC ID: 7416386685 Enrollment ID: I20230406002391 |
| Provider Name | William F Dotson |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1033343579 PECOS PAC ID: 7719103332 Enrollment ID: I20230503001895 |
| Provider Name | Chidubem G Ugwueze |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1841714029 PECOS PAC ID: 1658617899 Enrollment ID: I20230519000439 |
| Provider Name | Shawdon S Molavi |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1366805137 PECOS PAC ID: 4981969326 Enrollment ID: I20230706003227 |
| Provider Name | Akshai A Subramanian |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1831551100 PECOS PAC ID: 6608101936 Enrollment ID: I20230718000942 |
| Provider Name | Karli Whittam |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1639123300 PECOS PAC ID: 4183662026 Enrollment ID: I20231127001315 |
| Provider Name | Humberto Trevino |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1841814209 PECOS PAC ID: 5193147312 Enrollment ID: I20240123004736 |
Gps Ii Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5402 Sw Joshua St, Tualatin, OR 97062 Phone: 503-201-9811 | |
Michael P. Gardner, Md Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 19260 Sw 65th Ave Ste 310, Tualatin, OR 97062 Phone: 503-692-1200 Fax: 503-692-1220 | |
Tualatin Internal Medicine Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 6485 Sw Borland Rd Ste B, Tualatin, OR 97062 Phone: 503-272-8825 Fax: 503-427-9321 | |
Virginia Garcia Memorial Health Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 11300 Sw Hazelbrook Rd, Tualatin, OR 97062 Phone: 503-431-5100 | |
Jimmy Huebert Md Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 6464 Sw Borland Rd Ste D2, Tualatin, OR 97062 Phone: 503-885-8008 Fax: 503-885-8002 | |
Frank S. Rosenbloom, M.d. Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 6464 Sw Borland Rd, Suite B2, Tualatin, OR 97062 Phone: 503-692-5250 Fax: 503-612-0573 |