| Legacy Mount Hood Medical Center | |
|
24800 Se Stark St Gresham OR 97030-3378 | |
| (503) 413-5089 | |
| (503) 413-1860 |
| Full Name | Legacy Mount Hood Medical Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 24800 Se Stark St, Gresham, Oregon |
| Authorized Official Name and Position | Linda Hoff (SENIOR VP AND CFO) |
| Authorized Official Contact | 5034155730 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Legacy Mount Hood Medical Center Po Box 4365 Portland OR 97208-4365 Ph: (503) 413-3958 | Legacy Mount Hood Medical Center 24800 Se Stark St Gresham OR 97030-3378 Ph: (503) 413-5089 |
| NPI Number | 1386919132 |
|---|---|
| Provider Enumeration Date | 03/13/2012 |
| Last Update Date | 04/02/2015 |
| Medicare PECOS PAC ID | 3173515996 |
|---|---|
| Medicare Enrollment ID | O20040401000550 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386919132 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| 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 | 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 | Karen Joan Wesenberg |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1811980998 PECOS PAC ID: 0042209744 Enrollment ID: I20040508000015 |
| Provider Name | Michelle L John |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1336108208 PECOS PAC ID: 8325010192 Enrollment ID: I20040811000994 |
| Provider Name | Bradley H Evans |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1568464261 PECOS PAC ID: 6103724604 Enrollment ID: I20051020001106 |
| Provider Name | Julie E Yeggy |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1770550626 PECOS PAC ID: 7012928203 Enrollment ID: I20060602000069 |
| Provider Name | Manish Mehta |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1750310173 PECOS PAC ID: 8921002593 Enrollment ID: I20060913000261 |
| 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 | Vandy L Sherbin |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1083711857 PECOS PAC ID: 1052410644 Enrollment ID: I20070622000109 |
| Provider Name | Eric E Swiridoff |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1467456053 PECOS PAC ID: 2062511413 Enrollment ID: I20070626000154 |
| Provider Name | Christopher Ginocchio |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1346274131 PECOS PAC ID: 0446350433 Enrollment ID: I20070703000704 |
| 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 | Charles M Wood |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1902961907 PECOS PAC ID: 0244333607 Enrollment ID: I20071210000253 |
| Provider Name | Holly I Tse |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1912089947 PECOS PAC ID: 9234219304 Enrollment ID: I20071231000569 |
| Provider Name | Annette L Cole |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1407986581 PECOS PAC ID: 9739265273 Enrollment ID: I20080325000435 |
| 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 | Robert Francis 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 | Ellen L Young |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1760408850 PECOS PAC ID: 7517981244 Enrollment ID: I20081125000488 |
| Provider Name | Rebecca G Hills |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1942259833 PECOS PAC ID: 6800950593 Enrollment ID: I20090123000528 |
| Provider Name | Sajal C Dutta |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1528055548 PECOS PAC ID: 2365507654 Enrollment ID: I20090220000280 |
| Provider Name | Jin Hee Kim |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1043207871 PECOS PAC ID: 8022173152 Enrollment ID: I20090224000452 |
| Provider Name | Rhonda K Knight |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538341490 PECOS PAC ID: 9436200300 Enrollment ID: I20090706000688 |
| 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 | Alan Perry Hendin |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1437127644 PECOS PAC ID: 4183750995 Enrollment ID: I20100331000876 |
| Provider Name | Jay P Brown |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1306874037 PECOS PAC ID: 0446387716 Enrollment ID: I20100416000719 |
| Provider Name | Kelly F Scott |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1144294885 PECOS PAC ID: 5799819173 Enrollment ID: I20100820000603 |
| Provider Name | Aruna Jayaram |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1720308620 PECOS PAC ID: 1254456940 Enrollment ID: I20100917001113 |
| Provider Name | Marie Juliette Budesa |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1750563946 PECOS PAC ID: 8224169487 Enrollment ID: I20101014000844 |
| 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 | Gwen Grewe |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1326014234 PECOS PAC ID: 2961696240 Enrollment ID: I20101101000210 |
| Provider Name | Karen L Swenson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1992019947 PECOS PAC ID: 5294920690 Enrollment ID: I20101111000185 |
| Provider Name | Kathryn L Huyssoon |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1023000387 PECOS PAC ID: 6901091040 Enrollment ID: I20101115000420 |
| Provider Name | Coral A Nash |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912142746 PECOS PAC ID: 2264598358 Enrollment ID: I20110404000621 |
| Provider Name | Khashayar Farsad |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1376578609 PECOS PAC ID: 8224169313 Enrollment ID: I20110810000191 |
| 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 | Nasreen A Ilias-khan |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1538281399 PECOS PAC ID: 8022289875 Enrollment ID: I20110927000616 |
| 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 | Ryan Alexander Priest |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1144475567 PECOS PAC ID: 8426209404 Enrollment ID: I20121126000209 |
| 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 | 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 | Laura Ostrom |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1528371382 PECOS PAC ID: 1850526955 Enrollment ID: I20131025001590 |
| Provider Name | Kara A Kaiser |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1265624530 PECOS PAC ID: 2264527852 Enrollment ID: I20140313002118 |
| Provider Name | Masahiro Horikawa |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1538587118 PECOS PAC ID: 9436374147 Enrollment ID: I20140711001578 |
| Provider Name | Daniel Alexander Ananyev |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1255678439 PECOS PAC ID: 1052537255 Enrollment ID: I20140724000913 |
| 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 | Amish J Desai |
|---|---|
| Provider Type | Practitioner - Interventional 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 | Nishanie J Bisorca |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1801052477 PECOS PAC ID: 6406902014 Enrollment ID: I20150625000690 |
| 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 | Sean Robert Schulz |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164866885 PECOS PAC ID: 4183846017 Enrollment ID: I20160930000345 |
| 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 | Jane T Luu |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1124281423 PECOS PAC ID: 4587812664 Enrollment ID: I20170717003387 |
| Provider Name | Nikolaus A Kashey |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1538155775 PECOS PAC ID: 4183653389 Enrollment ID: I20170717003501 |
| 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 | Elizabeth Alston |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205348539 PECOS PAC ID: 4981967726 Enrollment ID: I20180410000712 |
| Provider Name | Rebecca L Corbett |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1912391830 PECOS PAC ID: 9032424171 Enrollment ID: I20180807001819 |
| Provider Name | Samuel W Bullick |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1386904662 PECOS PAC ID: 2860633286 Enrollment ID: I20181022002155 |
| 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 | Jennifer Dawn Logan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598039984 PECOS PAC ID: 6103071139 Enrollment ID: I20190416000239 |
| Provider Name | Brian Matthew Blair |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1770826372 PECOS PAC ID: 2567742737 Enrollment ID: I20190613003347 |
| 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 | Tenzin D Gorab |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700277001 PECOS PAC ID: 0941638431 Enrollment ID: I20200323000970 |
| Provider Name | Margie N L Tucker |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1477725794 PECOS PAC ID: 2769608397 Enrollment ID: I20200403002337 |
| 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 | Ryan Yuan |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1225189772 PECOS PAC ID: 2668441858 Enrollment ID: I20200917002538 |
| Provider Name | Mayank Agrawal |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1831308063 PECOS PAC ID: 5799816096 Enrollment ID: I20210218000928 |
| Provider Name | Joel Masami Oyama |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154915338 PECOS PAC ID: 9739595042 Enrollment ID: I20210311001885 |
| Provider Name | Abigail Marie Pardo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861087538 PECOS PAC ID: 9032527924 Enrollment ID: I20210413002989 |
| 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 | 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 | Mark T Day |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1225492796 PECOS PAC ID: 2466722897 Enrollment ID: I20211203001985 |
| Provider Name | Colby A. Richardson |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1558724799 PECOS PAC ID: 2567866973 Enrollment ID: I20211208003192 |
| Provider Name | Moses Chibuzo Azubuike |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1700232105 PECOS PAC ID: 8729353156 Enrollment ID: I20220314001929 |
| Provider Name | Ryan D Meek |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1275923146 PECOS PAC ID: 6305110891 Enrollment ID: I20220526000072 |
| Provider Name | Steven J Gangloff |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1952756058 PECOS PAC ID: 4587951637 Enrollment ID: I20220826003015 |
| Provider Name | Daniel J Henery |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1932606407 PECOS PAC ID: 8325397268 Enrollment ID: I20220901001051 |
| Provider Name | Nicholas E Calvo |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1972958593 PECOS PAC ID: 4183918279 Enrollment ID: I20221014002260 |
| Provider Name | Madhavi Murthy |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1144323619 PECOS PAC ID: 5890947154 Enrollment ID: I20221221003161 |
| Provider Name | Tara Dawn Marlett |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1962988154 PECOS PAC ID: 4587035266 Enrollment ID: I20230116000876 |
| Provider Name | Philippe Gerard Douyon |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1306169487 PECOS PAC ID: 3072755396 Enrollment ID: I20230405001477 |
| Provider Name | Mehwish Farooqi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1750872214 PECOS PAC ID: 7416386685 Enrollment ID: I20230406002391 |
| Provider Name | Chidubem G Ugwueze |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1841714029 PECOS PAC ID: 1658617899 Enrollment ID: I20230519000439 |
| Provider Name | Timothy F Simpson |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1396187696 PECOS PAC ID: 8820329261 Enrollment ID: I20230522002718 |
| 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 | Avnish Tripathi |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1801150214 PECOS PAC ID: 0244581916 Enrollment ID: I20240108004414 |
| Provider Name | Pradeep Chandan |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1245735968 PECOS PAC ID: 3779839006 Enrollment ID: I20240712003828 |
| Provider Name | Charise L Monte |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093314874 PECOS PAC ID: 7618387119 Enrollment ID: I20241115000673 |
| Provider Name | Stephanie Grove |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811614084 PECOS PAC ID: 9234509167 Enrollment ID: I20241223002238 |
Roberts Street Clinic, P.c. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 400 Ne Roberts Ave, Gresham, OR 97030 Phone: 503-669-3066 Fax: 503-665-6404 | |
Providence Health & Services - Oregon Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 440 Nw Division St, Gresham, OR 97030 Phone: 503-215-9500 Fax: 503-215-9525 | |
Gresham Women's Health Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 515 Ne Roberts Ave, Gresham, OR 97030 Phone: 503-477-2478 | |
Gresham Internal Medicine Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 24900 Se Stark St Ste 109, Gresham, OR 97030 Phone: 503-667-1015 Fax: 503-667-0406 | |
Mobile Vaccs Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3838 Se Saint Andrews Pl, Gresham, OR 97080 Phone: 503-858-7403 | |
Cascadia Behavioral Healthcare Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 400 Ne 7th St, Gresham, OR 97030 Phone: 503-238-0769 Fax: 503-889-2599 | |
Legacy Mount Hood Medical Center Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 24800 Se Stark St, Gresham, OR 97030 Phone: 503-674-1122 |