| Legacy Mount Hood Providers | |
|
24800 Se Stark St Gresham OR 97030-3378 | |
| (503) 413-5089 | |
| (503) 413-1860 |
| Full Name | Legacy Mount Hood Providers |
|---|---|
| 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 Providers Po Box 4365 Portland OR 97208-4365 Ph: (503) 413-3958 | Legacy Mount Hood Providers 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 | Robert Earl Barton |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1639187164 PECOS PAC ID: 8224939988 Enrollment ID: I20040115000877 |
| 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 | Kenneth L Rhoads |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1912904103 PECOS PAC ID: 1456348150 Enrollment ID: I20040426001639 |
| Provider Name | Karen Joan Wesenberg |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1811980998 PECOS PAC ID: 0042209744 Enrollment ID: I20040508000015 |
| Provider Name | Alan Wayne Hurty |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1225020191 PECOS PAC ID: 9931199478 Enrollment ID: I20040515000556 |
| Provider Name | Jennifer M Gibson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1144299900 PECOS PAC ID: 4385634682 Enrollment ID: I20040518000231 |
| Provider Name | Kurt A Brewster |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1922270966 PECOS PAC ID: 4385628379 Enrollment ID: I20040616001274 |
| Provider Name | Ajay Tripuraneni |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1538120969 PECOS PAC ID: 5193797595 Enrollment ID: I20040806000801 |
| Provider Name | Michelle L John |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1336108208 PECOS PAC ID: 8325010192 Enrollment ID: I20040811000994 |
| Provider Name | Linda A Herman |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1629000443 PECOS PAC ID: 2264413822 Enrollment ID: I20040813000558 |
| Provider Name | Jeffrey J Brown |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1548218563 PECOS PAC ID: 8224098769 Enrollment ID: I20041019000159 |
| Provider Name | Sharon L Trujillo |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1457448771 PECOS PAC ID: 8729049523 Enrollment ID: I20041025000923 |
| Provider Name | David Arthur Schroeder |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1578568499 PECOS PAC ID: 2163486739 Enrollment ID: I20041113000064 |
| Provider Name | Kirk L Weller |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1235169566 PECOS PAC ID: 0547206823 Enrollment ID: I20050708000283 |
| 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 | Naji M Hamdan |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1679570873 PECOS PAC ID: 2163438227 Enrollment ID: I20060227000362 |
| 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 | Christopher Baldwin |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1033159074 PECOS PAC ID: 0042211914 Enrollment ID: I20070118000586 |
| 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 | Orhan Konez |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1114901386 PECOS PAC ID: 0143114025 Enrollment ID: I20070827000001 |
| Provider Name | Tamara K Lundberg |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093905044 PECOS PAC ID: 1759330566 Enrollment ID: I20071231000226 |
| 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 | John M Dempster |
|---|---|
| Provider Type | Practitioner - Other (physician) |
| Provider Identifiers | NPI Number: 1386854974 PECOS PAC ID: 8820161375 Enrollment ID: I20080717000209 |
| Provider Name | Eric J Putz |
|---|---|
| Provider Type | Practitioner - Cardiac Electrophysiology |
| Provider Identifiers | NPI Number: 1740272533 PECOS PAC ID: 1951481597 Enrollment ID: I20080808000344 |
| Provider Name | Gail A Moses |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1841259389 PECOS PAC ID: 5597774513 Enrollment ID: I20081010000101 |
| Provider Name | Kirk W Walker |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1922076546 PECOS PAC ID: 1456345834 Enrollment ID: I20081126000060 |
| Provider Name | Rebecca G Hills |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1942259833 PECOS PAC ID: 6800950593 Enrollment ID: I20090123000528 |
| Provider Name | Danielle D Hosmer |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1386767192 PECOS PAC ID: 3779629167 Enrollment ID: I20091015000594 |
| 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 | Jay P Brown |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1306874037 PECOS PAC ID: 0446387716 Enrollment ID: I20100416000719 |
| Provider Name | Jon Hobson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1700824505 PECOS PAC ID: 4587791710 Enrollment ID: I20100420000937 |
| Provider Name | Michael F Savage |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1164745303 PECOS PAC ID: 1355471616 Enrollment ID: I20100611000758 |
| 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 | Mischelle Mcmillan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1851461990 PECOS PAC ID: 0345203600 Enrollment ID: I20100903000940 |
| Provider Name | Aruna Jayaram |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1720308620 PECOS PAC ID: 1254456940 Enrollment ID: I20100917001113 |
| Provider Name | Marie J 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 | Jaspreet Kaur Khangura |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1194983593 PECOS PAC ID: 1951594050 Enrollment ID: I20101021000604 |
| Provider Name | Gwen Grewe |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1326014234 PECOS PAC ID: 2961696240 Enrollment ID: I20101101000210 |
| Provider Name | Kathryn L Huyssoon |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1023000387 PECOS PAC ID: 6901091040 Enrollment ID: I20101115000420 |
| Provider Name | Laura A Flath |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1780806125 PECOS PAC ID: 2466649728 Enrollment ID: I20101213000429 |
| Provider Name | Aura Theresa B De Olazo |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1063738128 PECOS PAC ID: 5799973814 Enrollment ID: I20101216000072 |
| Provider Name | Coral A Nash |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912142746 PECOS PAC ID: 2264598358 Enrollment ID: I20110404000621 |
| Provider Name | Avid G Farahani |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1558515338 PECOS PAC ID: 3870770001 Enrollment ID: I20110615000490 |
| 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 | Jerry M Tran |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1366618340 PECOS PAC ID: 8325219793 Enrollment ID: I20110914000647 |
| 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 | Natalie Ku |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1003943382 PECOS PAC ID: 9931374519 Enrollment ID: I20111209000222 |
| Provider Name | Nandita Chaturvedi Gupta |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1801862255 PECOS PAC ID: 2860440047 Enrollment ID: I20120905000277 |
| Provider Name | Beenish K Khwaja |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1487854329 PECOS PAC ID: 0840440715 Enrollment ID: I20121031000076 |
| 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 | Elizabeth A Phillips |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356615637 PECOS PAC ID: 4880834589 Enrollment ID: I20130701000053 |
| 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 | Druanne M Laplante |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1285691733 PECOS PAC ID: 0042100323 Enrollment ID: I20140425000014 |
| 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 | Veronica Mary Rayburn |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1063691608 PECOS PAC ID: 6507946225 Enrollment ID: I20141030001168 |
| Provider Name | Mary S Mckenzie |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1447417100 PECOS PAC ID: 6800027657 Enrollment ID: I20141204000680 |
| Provider Name | Allean C Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144540063 PECOS PAC ID: 8325164304 Enrollment ID: I20150417000893 |
| 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 | 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 | David H Delman |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1669764924 PECOS PAC ID: 4082833926 Enrollment ID: I20160831000741 |
| Provider Name | Samuel R. Glickman |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1912149790 PECOS PAC ID: 9638325186 Enrollment ID: I20160912000279 |
| Provider Name | Sara Marie Weber |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447703624 PECOS PAC ID: 0840586137 Enrollment ID: I20160913001769 |
| Provider Name | Sean Robert Schulz |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164866885 PECOS PAC ID: 4183846017 Enrollment ID: I20160930000345 |
| 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 | Peter D Jackson |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1598054132 PECOS PAC ID: 2668771148 Enrollment ID: I20170720003232 |
| Provider Name | Gurjeet Singh |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1780947937 PECOS PAC ID: 8224261763 Enrollment ID: I20170731001640 |
| Provider Name | Ratna Bitra |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1619347606 PECOS PAC ID: 1052681806 Enrollment ID: I20170801002863 |
| Provider Name | Angela M Gibbs |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1487034484 PECOS PAC ID: 1951614304 Enrollment ID: I20170818002042 |
| Provider Name | Shevyll Arvie S Tan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1376720052 PECOS PAC ID: 5193897080 Enrollment ID: I20180804000151 |
| 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 | 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 | Marwan Qattan |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1326355314 PECOS PAC ID: 8123245578 Enrollment ID: I20191003000319 |
| Provider Name | Paul C Ho |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1962558833 PECOS PAC ID: 1951588359 Enrollment ID: I20191231000938 |
| 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 | Yilun Koethe |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1982022778 PECOS PAC ID: 8123361417 Enrollment ID: I20200720000600 |
| Provider Name | Larissa M Brodsky |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1578090197 PECOS PAC ID: 8820366651 Enrollment ID: I20200813000104 |
| Provider Name | Ryan Yuan |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1225189772 PECOS PAC ID: 2668441858 Enrollment ID: I20200917002538 |
| Provider Name | James Boyd |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1720254204 PECOS PAC ID: 3476728908 Enrollment ID: I20201013002466 |
| Provider Name | Mayank Agrawal |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1831308063 PECOS PAC ID: 5799816096 Enrollment ID: I20210218000928 |
| 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 | 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 | Ryan D Meek |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1275923146 PECOS PAC ID: 6305110891 Enrollment ID: I20220526000072 |
| Provider Name | Steven Gangloff |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1952756058 PECOS PAC ID: 4587951637 Enrollment ID: I20220826003015 |
| 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 | David A White |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1194769513 PECOS PAC ID: 4385613314 Enrollment ID: I20240313003420 |
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 Medical Group 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 | |
Adventist Health Portland - Gresham Station #1 Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 831 Nw Council Dr Ste 101, Gresham, OR 97030 Phone: 503-665-8176 Fax: 503-665-8178 | |
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 | |
Gresham 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 |