ROBERTS STREET CLINIC, P.C. NPI 1003024423

Family Medicine in Gresham, OR

NPI 1003024423 Organization Family Medicine CLIA Number 38D0621896 CLIA Certificate of Accreditation

About ROBERTS STREET CLINIC, P.C.

Roberts Street Clinic, P.c. is a primary care provider established in Gresham, Oregon specializing in family medicine. The NPI number of Roberts Street Clinic, P.c. is 1003024423 and was assigned on May 2007. The practitioner's primary taxonomy code is 207Q00000X with license number DO18839 (OR). The provider is registered as an organization and their NPI record was last updated 14 years ago. Roberts Street Clinic, P.c. operates as a multi-specialty business group with one or more individual providers who practice different areas of specialization. The authorized official of this NPI record is Linda Mankey (Clinic Manager)

A primary care provider (PCP) like Roberts Street Clinic, P.c. sees people with common medical problems. The primary care provider might be a doctor, physician assistant, nurse practitioner or clinic that are usually involved in your long-term care. A PCP might provide preventive care, treat common medical conditions, identify urgent medical problems and refer you to specialists when necessary. Primary care is usually provided in an outpatient facility but if you are admitted to a hospital your PCP may assist in your care. The most common medical conditions seen by primary care providers are: hypertension, upper respiratory tract infections, depression or anxiety, back pain, arthritis, dermatitis, diabetes, urinary tract infections, etc

The CLIA number of Roberts Street Clinic, P.c. is 38D0621896 registered as a "physician office" facility with a CLIA Certificate of Accreditation. This is a CLIA certificate is issued to Roberts Street Clinic, P.c. on the basis of the laboratory's accreditation by an accreditation organization approved by CMS. This type of certificate is issued to a laboratories tha perform nonwaived (moderate and/or high complexity) testing.

NPI

1003024423

Provider NameROBERTS STREET CLINIC, P.C.
Provider Location Address400 NE ROBERTS AVE GRESHAM, OR 97030
Provider Mailing Address400 NE ROBERTS AVE GRESHAM, OR 97030
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Enumeration Date05-18-2007
Last Update Date10-10-2007


Primary Taxonomy

Taxonomy Code207Q00000X
ClassificationFamily Medicine
TypeAllopathic & Osteopathic Physicians
License No.DO18839
License StateOR
Taxonomy DescriptionFamily Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

Business Address

ROBERTS STREET CLINIC, P.C.
400 NE ROBERTS AVE
GRESHAM, OR
ZIP 97030
Phone: (503) 669-3066
Fax: (503) 665-6404

Get Directions


Mailing Address

ROBERTS STREET CLINIC, P.C.
400 NE ROBERTS AVE
GRESHAM, OR
ZIP 97030
Phone: (503) 669-3066
Fax: (503) 665-6404



Authorized Official

Authorized Official Name LINDA MANKEY
Authorized Official TitleCLINIC MANAGER
Authorized Official Phone(503) 669-3066

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for the NPI number 1003024423 is:

CLIA Number38D0621896
Facility TypePHYSICIAN OFFICE
Certificate TypeCertificate of Accreditation

Group Taxonomy


193200000X MULTI-SPECIALTY GROUP - This provider is a business group of one or more individual practitioners, who practice with different areas of specialization.

Secondary Taxonomies


The secondary taxonomy codes define the provider type, classification, and specialization. For individual NPIs the license data is associated to each taxonomy code.

No. Taxonomy Code Type Classification Specialization License No. State Primary
1207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineDO15150ORNo

Taxonomy Description: family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

2207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineDO21884ORNo

Taxonomy Description: family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

3207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineMD17149ORNo

Taxonomy Description: a physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
08WFBBRAMEDICARE ID-TYPE UNSPECIFIED (04)OR
011WFBBRAMEDICARE ID-TYPE UNSPECIFIED (04)OR
287698MEDICAID (05)OR
205823MEDICAID (05)OR
D80358MEDICARE UPIN (02)OR
H34118MEDICARE UPIN (02)OR
079546MEDICAID (05)OR
G23129MEDICARE UPIN (02)OR
287658MEDICAID (05)OR
109162MEDICARE ID-TYPE UNSPECIFIED (04)OR
0000WFBBRMEDICARE ID-TYPE UNSPECIFIED (04)OR
029582MEDICAID (05)OR
E96441MEDICARE UPIN (02)OR
118823MEDICARE ID-TYPE UNSPECIFIED (04)OR

Other Providers at the same location


The following 4 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1851387849 TONI LORAINE HERO D.O.
Individual
Family Medicine400 NE ROBERTS AVE
GRESHAM, OR 97030
(503) 665-9144
1114913183 GORDON PAUL CANZLER D.O.
Individual
Family Medicine400 NE ROBERTS AVE
GRESHAM, OR 97030
(503) 665-9144
1700872785 STEVEN DOUGLAS MANESS M.D.
Individual
Internal Medicine400 NE ROBERTS AVE
GRESHAM, OR 97030
(503) 665-9144
1407842487 MATTHEW CLAY UPSHAW D.O.
Individual
Family Medicine400 NE ROBERTS AVE
GRESHAM, OR 97030
(503) 665-9144

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.