| |
703 Ne Hancock St Portland OR 97212-3955 | |
(503) 230-9875 | |
(503) 331-3441 |
Full Name | |
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Speciality | Clinic/Center |
Location | 703 Ne Hancock St, Portland, Oregon |
Authorized Official Name and Position | Sarah Ayers (CREDENTIALING SPECIALIST) |
Authorized Official Contact | 5033679089 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1776 Sw Madison St Portland OR 97205 Ph: (503) 224-1044 | 703 Ne Hancock St Portland OR 97212-3955 Ph: (503) 230-9875 |
NPI Number | 1396734364 |
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Provider Enumeration Date | 10/20/2005 |
Last Update Date | 03/29/2024 |
Medicare PECOS PAC ID | 2668361585 |
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Medicare Enrollment ID | O20040310001435 |
Identifier | Type | State | Issuer |
---|---|---|---|
1396734364 | NPI | - | NPPES |
126370 | Medicaid | OR | |
2006165 | Medicaid | WA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Provider Name | Marcela J Vinocur |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1750370680 PECOS PAC ID: 6305827916 Enrollment ID: I20040528000740 |
Provider Name | Artice E Geary |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1508856188 PECOS PAC ID: 6002855004 Enrollment ID: I20050428001011 |
Provider Name | Amy S Earhart |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1790885796 PECOS PAC ID: 4486660578 Enrollment ID: I20060227000572 |
Provider Name | Sheila Nm Heuschkel |
---|---|
Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
Provider Identifiers | NPI Number: 1689703183 PECOS PAC ID: 1456410224 Enrollment ID: I20081107000552 |
Provider Name | Margaret M Hayes |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1437164951 PECOS PAC ID: 7113825258 Enrollment ID: I20081205000809 |
Provider Name | Christopher M Cirino |
---|---|
Provider Type | Practitioner - Infectious Disease |
Provider Identifiers | NPI Number: 1740382613 PECOS PAC ID: 0042261992 Enrollment ID: I20100118000072 |
Provider Name | Susannah Martell |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1912358730 PECOS PAC ID: 6103104518 Enrollment ID: I20161104001170 |
Provider Name | Heidi Marie Nicewander |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1023414463 PECOS PAC ID: 0547539421 Enrollment ID: I20170710000091 |
Provider Name | Lillian J Yasana |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1255693073 PECOS PAC ID: 9638442387 Enrollment ID: I20170831002781 |
Provider Name | Judy Ann Hart |
---|---|
Provider Type | Practitioner - Other (physician) |
Provider Identifiers | NPI Number: 1720094956 PECOS PAC ID: 9537409529 Enrollment ID: I20190329001891 |
Provider Name | Perla Castillo Palacios |
---|---|
Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
Provider Identifiers | NPI Number: 1477136901 PECOS PAC ID: 8921417387 Enrollment ID: I20210514001488 |
Provider Name | David Carl Stevens |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1255095550 PECOS PAC ID: 8426432964 Enrollment ID: I20220831003184 |
Provider Name | Deanna Lynn Schlegel |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1245966597 PECOS PAC ID: 6103200670 Enrollment ID: I20220901000222 |
Provider Name | Tamara Renee Sanderson Dissanayake |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1457771305 PECOS PAC ID: 5193945806 Enrollment ID: I20221215003161 |
Provider Name | Hannah R Zweifel |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1609404755 PECOS PAC ID: 4880019595 Enrollment ID: I20230203000433 |
Provider Name | Lindy D Resner |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1093338485 PECOS PAC ID: 2860858164 Enrollment ID: I20230511000838 |
Provider Name | Daniela R Dogar |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1740659481 PECOS PAC ID: 3779014733 Enrollment ID: I20241001002222 |
Provider Name | Katie A Schoonover |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1972019271 PECOS PAC ID: 0749711638 Enrollment ID: I20241002002942 |
Provider Name | Stephanie Mara Wichmann |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1740636364 PECOS PAC ID: 9335670082 Enrollment ID: I20241004001455 |
Provider Name | Jeremy Patrick Boal |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1730814005 PECOS PAC ID: 5698206134 Enrollment ID: I20241008001775 |
Provider Name | Lorin Kroeger |
---|---|
Provider Type | Practitioner - Other (non-physician) |
Provider Identifiers | NPI Number: 1992198394 PECOS PAC ID: 3870027287 Enrollment ID: I20241107002630 |
Provider Name | Lorin Kroeger |
---|---|
Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1992198394 PECOS PAC ID: 3870027287 Enrollment ID: I20241111000794 |
Provider Name | Madeline Lehman |
---|---|
Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1366013427 PECOS PAC ID: 3072047240 Enrollment ID: I20241111001361 |
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 | |
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 | |