Broadway Medical Clinic Llp - Medicare Primary Care in Portland, OR

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Broadway Medical Clinic Llp is a medicare enrolled primary clinic (Clinic/center - Primary Care) in Portland, Oregon. The current practice location for Broadway Medical Clinic Llp is 4212 Ne Broadway St, Portland, Oregon. For appointments, you can reach them via phone at (503) 249-8787. The mailing address for Broadway Medical Clinic Llp is 4212 Ne Broadway St, Portland, Oregon and phone number is (503) 249-8787.

Broadway Medical Clinic Llp is licensed to practice in Oregon (license number ). The clinic also participates in the medicare program and its NPI number is 1720082316. This medical practice accepts medicare insurance (which means this clinic accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance). However, please confirm if they accept your insurance at (503) 249-8787.

Contact Information

Broadway Medical Clinic Llp
4212 Ne Broadway St
Portland
OR 97213-1460
(503) 249-8787
(503) 284-5168

Map and Direction


Primary Care Clinic Profile

Full NameBroadway Medical Clinic Llp
SpecialityClinic/Center
Location4212 Ne Broadway St, Portland, Oregon
Authorized Official Name and PositionCandy S Chapman (ADMINISTRATOR)
Authorized Official Contact5033317650
Accepts Medicare InsuranceYes. This clinic participates in medicare program and accept medicare insurance.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Broadway Medical Clinic Llp
4212 Ne Broadway St
Portland
OR 97213-1460

Ph: (503) 249-8787		Broadway Medical Clinic Llp
4212 Ne Broadway St
Portland
OR 97213-1460

Ph: (503) 249-8787

NPI Details:

NPI Number1720082316
Provider Enumeration Date06/10/2005
Last Update Date07/21/2022

Medicare PECOS Information:

Medicare PECOS PAC ID2466447610
Medicare Enrollment IDO20040416001171

Medical Identifiers

Medical identifiers for Broadway Medical Clinic Llp such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1720082316NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
261QP2300XClinic/center - Primary Care (Oregon)Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Broadway Medical Clinic Llp acts as a billing entity for following providers:
Provider NameLuis A Valls
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1013084573
PECOS PAC ID: 1951386267
Enrollment ID: I20040621001871
Provider NameThao T P Nguyen
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1689609364
PECOS PAC ID: 2062497910
Enrollment ID: I20040623001048
Provider NameDennis E Bley
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1720146152
PECOS PAC ID: 7810962917
Enrollment ID: I20040901000381
Provider NameDaniel R Kocarnik
Provider TypePractitioner - Diagnostic Radiology
Provider IdentifiersNPI Number: 1245346758
PECOS PAC ID: 5496795684
Enrollment ID: I20050506000425
Provider NameChristopher J Altenhofen
Provider TypePractitioner - Diagnostic Radiology
Provider IdentifiersNPI Number: 1043327547
PECOS PAC ID: 7012957228
Enrollment ID: I20050506000539
Provider NameAnne M Hirsch
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1407916513
PECOS PAC ID: 8729032750
Enrollment ID: I20070724000164
Provider NameBenjamin D Ehst
Provider TypePractitioner - Dermatology
Provider IdentifiersNPI Number: 1740320068
PECOS PAC ID: 3678664489
Enrollment ID: I20070808000701
Provider NameCharles M Wood
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1902961907
PECOS PAC ID: 0244333607
Enrollment ID: I20071210000253
Provider NameCraig S Davis
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1508975715
PECOS PAC ID: 8628158656
Enrollment ID: I20080103000512
Provider NameDouglas E Renouard
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1568539195
PECOS PAC ID: 1557315587
Enrollment ID: I20090305000007
Provider NameJohn E Bauer
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1902972813
PECOS PAC ID: 5991759920
Enrollment ID: I20101201000807
Provider NameMarjorie J Hrbek
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1053488718
PECOS PAC ID: 4183678113
Enrollment ID: I20101201001052
Provider NameLaurel L Simon
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1417024902
PECOS PAC ID: 7911951942
Enrollment ID: I20101201001120
Provider NameCharles L Darby
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1942376850
PECOS PAC ID: 0547214579
Enrollment ID: I20101201001179
Provider NameJanis L Howatt
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1437225257
PECOS PAC ID: 6901850932
Enrollment ID: I20101207000966
Provider NameMary Lee Baker
Provider TypePractitioner - Pediatric Medicine
Provider IdentifiersNPI Number: 1073670832
PECOS PAC ID: 1355395377
Enrollment ID: I20101230000538
Provider NameClytie S Rimberg
Provider TypePractitioner - Dermatology
Provider IdentifiersNPI Number: 1477620029
PECOS PAC ID: 9739133760
Enrollment ID: I20110215000562
Provider NameCynthia Tortorelli
Provider TypePractitioner - Diagnostic Radiology
Provider IdentifiersNPI Number: 1326001835
PECOS PAC ID: 4688664667
Enrollment ID: I20111118000573
Provider NameVictoria L Keyton
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1124008461
PECOS PAC ID: 4284641523
Enrollment ID: I20141031002233
Provider NameGabriel P Currie
Provider TypePractitioner - Pathology
Provider IdentifiersNPI Number: 1942513924
PECOS PAC ID: 5092020735
Enrollment ID: I20150810003203
Provider NameMichael Grandfield Mazzotta
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1841427572
PECOS PAC ID: 3072748185
Enrollment ID: I20170109001556
Provider NameGrace E Jazrawi
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1720213366
PECOS PAC ID: 7113177262
Enrollment ID: I20171020001317
Provider NameJaya Madhav
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1770970048
PECOS PAC ID: 5193030138
Enrollment ID: I20181108000820
Provider NameStephanie Campbell
Provider TypePractitioner - Dermatology
Provider IdentifiersNPI Number: 1588957864
PECOS PAC ID: 1254655905
Enrollment ID: I20190321002278
Provider NameTracy L Hansen
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1326494576
PECOS PAC ID: 8123311768
Enrollment ID: I20191028001183
Provider NamePatrick T Hassenfritz
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1992348999
PECOS PAC ID: 7911311204
Enrollment ID: I20210127003171
Provider NameEunsook G Lim
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1346742236
PECOS PAC ID: 3577826940
Enrollment ID: I20210203001157
Provider NameMarcella A Shook
Provider TypePractitioner - Clinical Social Worker
Provider IdentifiersNPI Number: 1851756795
PECOS PAC ID: 7719357318
Enrollment ID: I20221222001537
Provider NameVanessa Hutton
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1720723851
PECOS PAC ID: 5799155164
Enrollment ID: I20221228003078

Reviews and Comments


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Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.