| Fanno Creek Clinic Llc | |
|
2400 Sw Vermont St Portland OR 97219-1940 | |
| (503) 452-0915 | |
| (503) 768-9232 |
| Full Name | Fanno Creek Clinic Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 2400 Sw Vermont St, Portland, Oregon |
| Authorized Official Name and Position | Larry M Reed (CLINIC MANAGER) |
| Authorized Official Contact | 5034520915 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fanno Creek Clinic Llc 2400 Sw Vermont St Portland OR 97219-1940 Ph: (503) 452-0915 | Fanno Creek Clinic Llc 2400 Sw Vermont St Portland OR 97219-1940 Ph: (503) 452-0915 |
| NPI Number | 1609876705 |
|---|---|
| Provider Enumeration Date | 07/29/2005 |
| Last Update Date | 10/16/2007 |
| Medicare PECOS PAC ID | 0042100521 |
|---|---|
| Medicare Enrollment ID | O20040318000244 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609876705 | NPI | - | NPPES |
| 151070 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 2802 (Oregon) | Primary |
| 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 | Leesa M Azar |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1629012315 PECOS PAC ID: 9436129244 Enrollment ID: I20040805001415 |
| Provider Name | Edmund H Torkelson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1083701833 PECOS PAC ID: 3779544010 Enrollment ID: I20041020001079 |
| Provider Name | Louise A Mcharris |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1518928563 PECOS PAC ID: 9234197096 Enrollment ID: I20041227000317 |
| Provider Name | Geoffrey M Wilson |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1336185438 PECOS PAC ID: 3870493786 Enrollment ID: I20051219000124 |
| Provider Name | Kenton W Gregory |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1922080480 PECOS PAC ID: 9032125182 Enrollment ID: I20060227000319 |
| Provider Name | Larry D Jensen |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1851383269 PECOS PAC ID: 3476562091 Enrollment ID: I20060410000629 |
| Provider Name | Charles J Bentz |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1518995851 PECOS PAC ID: 6406937911 Enrollment ID: I20080122000525 |
| Provider Name | Charles H Kuttner |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1417954512 PECOS PAC ID: 1850451170 Enrollment ID: I20081117000522 |
| Provider Name | Angela T Marshall Olson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1841493988 PECOS PAC ID: 4284771429 Enrollment ID: I20091021000302 |
| Provider Name | Lorraine B Woskow |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1386612430 PECOS PAC ID: 7416083233 Enrollment ID: I20100331001027 |
| Provider Name | Myrna Antonio Casono |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1588666432 PECOS PAC ID: 3971630088 Enrollment ID: I20100421000902 |
| Provider Name | Donald A Valerio |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1962402586 PECOS PAC ID: 0547394041 Enrollment ID: I20100819000714 |
| Provider Name | Marc G Levitte |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1699775742 PECOS PAC ID: 5294869632 Enrollment ID: I20100819001241 |
| Provider Name | Gregg O Coodley |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1871593491 PECOS PAC ID: 1153446836 Enrollment ID: I20100917001001 |
| Provider Name | George B Demetrion |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1326048950 PECOS PAC ID: 4385836998 Enrollment ID: I20101013001256 |
| Provider Name | Kathrine Elaine Avison |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1124126636 PECOS PAC ID: 5092816538 Enrollment ID: I20101020000140 |
| Provider Name | Angela M Stearns |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1902975071 PECOS PAC ID: 0345341277 Enrollment ID: I20101027000077 |
| Provider Name | Meei Y Choong |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1386644896 PECOS PAC ID: 1658565098 Enrollment ID: I20101029001299 |
| Provider Name | Michele N Dickson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619957990 PECOS PAC ID: 9830121110 Enrollment ID: I20110118000998 |
| Provider Name | Susan Yeh |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1023025152 PECOS PAC ID: 1052588373 Enrollment ID: I20120126000688 |
| Provider Name | Jessica D Benedict |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740542919 PECOS PAC ID: 2264689157 Enrollment ID: I20120828000846 |
| Provider Name | Jeffrey I Gerry |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1396727400 PECOS PAC ID: 7719135953 Enrollment ID: I20120913000500 |
| Provider Name | Nicholas A Kuhn |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1053457937 PECOS PAC ID: 0648326660 Enrollment ID: I20121219000512 |
| Provider Name | Christina Oliver |
|---|---|
| Provider Type | Practitioner - Preventive Medicine |
| Provider Identifiers | NPI Number: 1386953115 PECOS PAC ID: 2567617491 Enrollment ID: I20150115001080 |
| Provider Name | Rebekah J Ratzlaff |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1366793093 PECOS PAC ID: 8527372051 Enrollment ID: I20150728006142 |
| Provider Name | Malika Burman |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1912123662 PECOS PAC ID: 5395049340 Enrollment ID: I20160211001061 |
| Provider Name | Christopher Kauffman |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1316110364 PECOS PAC ID: 1254571912 Enrollment ID: I20160620000827 |
| Provider Name | Jennifer L Yeast |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1285996926 PECOS PAC ID: 2062733900 Enrollment ID: I20160926002411 |
| Provider Name | Iris N Briand |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1871017723 PECOS PAC ID: 5890069702 Enrollment ID: I20170915001584 |
| Provider Name | Paul Michael Kaminsky |
|---|---|
| Provider Type | Practitioner - Colorectal Surgery (proctology) |
| Provider Identifiers | NPI Number: 1295173763 PECOS PAC ID: 2466748058 Enrollment ID: I20191212000977 |
| Provider Name | Jennifer S Booth |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598076986 PECOS PAC ID: 9133555618 Enrollment ID: I20200131000154 |
| Provider Name | Gheorghe E Plesiu |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1902162829 PECOS PAC ID: 7719124718 Enrollment ID: I20200323001175 |
| Provider Name | Luciana Arcas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902237613 PECOS PAC ID: 4183001662 Enrollment ID: I20220523002050 |
| Provider Name | Serge Sicular |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1326276866 PECOS PAC ID: 0941442958 Enrollment ID: I20221206002981 |
| Provider Name | Howard Kessler |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1477500775 PECOS PAC ID: 2769387620 Enrollment ID: I20230418002652 |
| Provider Name | Anthony Hamame |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1184872327 PECOS PAC ID: 8022250752 Enrollment ID: I20230419001897 |
| Provider Name | Wendell Wilmoth |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1245499003 PECOS PAC ID: 8123258746 Enrollment ID: I20230511003242 |
| Provider Name | Marisa Crenshaw |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124295852 PECOS PAC ID: 4789732488 Enrollment ID: I20230515003011 |
| Provider Name | Michael Ramsay |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1942272562 PECOS PAC ID: 5092709014 Enrollment ID: I20230517002073 |
| Provider Name | Johnathan Hays |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1366654162 PECOS PAC ID: 5698825867 Enrollment ID: I20230717002627 |
| Provider Name | Leyla Nasehi |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1043629504 PECOS PAC ID: 3577859271 Enrollment ID: I20230720001118 |
| Provider Name | William Strimel |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1366425134 PECOS PAC ID: 0345243028 Enrollment ID: I20230728000821 |
| Provider Name | Tejas Patel |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1861768152 PECOS PAC ID: 9739481292 Enrollment ID: I20230728001486 |
| Provider Name | Paul Depippo |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1114939063 PECOS PAC ID: 9830126051 Enrollment ID: I20231229000766 |
| Provider Name | Autumn Lebank |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1417221979 PECOS PAC ID: 1557642063 Enrollment ID: I20240328001818 |
| Provider Name | Jamie Giesbrandt |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1700020179 PECOS PAC ID: 3779720289 Enrollment ID: I20240502003282 |
| Provider Name | Samantha Avery |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1215178090 PECOS PAC ID: 0143443697 Enrollment ID: I20240506003231 |
Woodstock Family Medicine Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5536 Se Woodstock Blvd, Portland, OR 97206 Phone: 503-236-1830 Fax: 503-236-1908 | |
Internal Medicine Consultants, P.c. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 9585 Sw Washington Square Rd, Portland, OR 97223 Phone: 503-320-2121 Fax: 503-641-4158 | |
The Wellness Center Pdx Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1359 Ne 35th Avenue, Portland, OR 97232 Phone: 503-389-5545 | |
Providence Medical Group Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 5211 Ne Glisan St Bldg C, Portland, OR 97213 Phone: 503-215-6628 Fax: 503-215-6240 | |
Interstate Medical Office West Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3325 N Interstate Ave, Portland, OR 97227 Phone: 800-813-2000 Fax: 503-286-6879 | |
Jenna Halbert, Nd Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 333 Ne Russell St Ste 207, Portland, OR 97212 Phone: 503-482-8301 | |
Cascadia Behavioral Healthcare, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 7511 Se Henry St, Portland, OR 97206 Phone: 503-771-6061 Fax: 503-771-7514 |