PROVIDENCE HEALTH & SERVICES OREGON
NPI 1003319724
Clinic/Center in Portland, OR

Q: What is Providence Health & Services Oregon's NPI number?

The NPI number for Providence Health & Services Oregon is 1003319724. It was assigned to this organization in the NPPES registry on March 9, 2018. The provider is doing business as Providence Medical Group.

Q: What is Providence Health & Services Oregon's specialty?

The primary specialty registered for this NPI is Clinic/Center with taxonomy code 261Q00000X.

Active since March 09, 2018

5211 NE GLISAN ST BLDG C, PORTLAND, OR 97213(503) 215-6628(503) 215-6240 Get Directions Write a Review

NPPES record last updated: June 20, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jun 20, 2025, May 15, 2025, Mar 9, 2018 (3 updates tracked since 2018).

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About Providence Health & Services Oregon NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PROVIDENCE HEALTH & SERVICES OREGON (NPI 1003319724), doing business as Providence Medical Group, is a healthcare organization registered as a clinic/center in Portland, Oregon and active in the NPI registry since March 2018. The organization lists Donald Wayne Anderson, Assistant Secretary Of Enrollments, as its authorized official.

NPPES Registry Identity

NPI1003319724

Entity TypeOrganization

Primary Taxonomy261Q00000X

Legal Business NamePROVIDENCE HEALTH & SERVICES OREGON

Location Address5211 NE GLISAN ST BLDG CPortland, OR 97213-3052

Mailing AddressPo Box 31001 - 4180Pasadena, CA 91110-4180 · (503) 215-6628 · Fax (503) 215-6240

Phone(503) 215-6628

Fax(503) 215-6240

Organization SubpartNo

Authorized OfficialDonald Wayne AndersonAssistant Secretary Of Enrollments · (425) 358-9786

Enumeration DateMarch 9, 2018

Last NPPES UpdateJune 20, 20253 updates tracked since enumeration

NPPES CertifiedJune 20, 2025

✔ NPI 1003319724 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyClinic/CenterAmbulatory Health Care Facilities

Taxonomy Code261Q00000X

Definition

A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

Also ListedInternal MedicineTaxonomy 207R00000X

5211 NE GLISAN ST BLDG C, Portland, OR 97213

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Other Names 1

Doing Business AsProvidence Medical Group

Group Practice 1

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

Areas of Expertise CMS Part B claims 2

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

The mdpp beneficiary achieved at least 5% weight loss (wl) from his/her baseline weight in months 1-12 of the mdpp services period under the mdpp expanded model (em). this is a one-time payment available when a beneficiary first achieves at least 5% weight G9880

The MDPP Expanded Model is a program that rewards weight loss. If a participant loses at least 5% of their baseline weight within the first year of the program, they receive a one-time payment. This incentive is only available the first time a participant achieves this weight loss goal.

21 services21 patients

The mdpp beneficiary achieved at least 9% weight loss (wl) from his/her baseline weight in months 1-24 under the mdpp expanded model (em). this is a one-time payment available when a beneficiary first achieves at least 9% weight loss from baseline as measu G9881

The MDPP Expanded Model is a program that supports healthy weight loss. If you, as a participant, lose at least 9% of your initial weight within the first 24 months, a one-time payment is made. This achievement is measured and rewarded to encourage your continued progress.

11 services11 patients

Other Providers at the Same Location NPPES 19

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SALLY JO NIEDERMEYER RN

Registered Nurse (Community Health)