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PROVIDENCE HEALTH & SERVICE - OREGON
NPI 1023738424
Program of All-Inclusive Care for the Elderly (PACE) Provider Organization in Portland, OR

Active since August 29, 2022
4400 NE HALSEY ST, BUILDING 1, STE 200, PORTLAND, OR 97213(503) 215-6556(503) 215-0685 Get Directions Write a Review

NPPES record last updated: May 16, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: May 16, 2025, Aug 29, 2022 (2 updates tracked since 2022).

About Providence Health & Service - Oregon NPPES

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

PROVIDENCE HEALTH & SERVICE - OREGON (NPI 1023738424), doing business as Providence Elderplace - Portland, is a healthcare organization registered as a program of all-inclusive care for the elderly (pace) provider organization in Portland, Oregon and active in the NPI registry since August 2022. The organization lists Donald Wayne Anderson, Assistant Secretary Of Enrollments, as its authorized official.

NPPES Registry Identity

NPI1023738424
Entity TypeOrganization
Primary Taxonomy251T00000X
Legal Business NamePROVIDENCE HEALTH & SERVICE - OREGON
Location Address4400 NE HALSEY ST, BUILDING 1, STE 200Portland, OR 97213
Mailing Address4400 Ne Halsey St, Building 1, Ste 200Portland, OR 97213 · (503) 215-6556
Phone(503) 215-6556
Fax(503) 215-0685
Organization SubpartYesParent: Providence Health & Services - Oregon
Authorized OfficialDonald Wayne AndersonAssistant Secretary Of Enrollments · (425) 358-9786
Enumeration DateAugust 29, 2022
Last NPPES UpdateMay 16, 20252 updates tracked since enumeration
NPPES CertifiedMay 16, 2025
✔ NPI 1023738424 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyProgram of All-Inclusive Care for the Elderly (PACE) Provider OrganizationAgencies
Taxonomy Code251T00000X
Definition
A PACE provider organization is a not-for-profit private or public entity that is primarily engaged in providing PACE services(unique capitated managed care benefits for the frail elderly which include comprehensive medical and social services). The following characteristics also apply to a PACE organization. It must: have a governing board that includes community representation; be able to provide complete PACE services regardless of frequency or duration of services; have a physical site to provide adult day services; have a defined service area; have safeguards against conflict of interest; have demonstrated fiscal soundness and have a formal Participant Bill of Rights.
4400 NE HALSEY ST, Portland, OR 97213
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Other Names 1

Doing Business AsProvidence Elderplace - Portland

Other Identifiers 1

Medicaid005673OR

Other Providers at the Same Location NPPES 20

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

CLARA MIKHAEIL PHARMD
Pharmacist (Ambulatory Care)
4400 NE HALSEY ST, BUILDING 2 SUITE 490
PORTLAND, OR 97213
Multnomah County (503) 893-6900
TEODORA FETEA RN
Registered Nurse (Ambulatory Care)
4400 NE HALSEY ST
PORTLAND, OR 97213
Multnomah County (971) 369-0571
DR. HEIDI L CHINWUBA PHARMD
Pharmacist (Pharmacotherapy)
4400 NE HALSEY ST, 4TH FLOOR
PORTLAND, OR 97213
Multnomah County (503) 893-6900
MARISA GILLASPIE AZIZ CNS
Clinical Nurse Specialist
4400 NE HALSEY ST
PORTLAND, OR 97213
Multnomah County (541) 610-3346
ANDREANA ROCHELLE JONES PMHNP
Nurse Practitioner (Psychiatric/Mental Health)
4400 NE HALSEY ST, BLDG 1, STE 200
PORTLAND, OR 97213
Multnomah County (503) 215-6556
CYNTHIA MEDRANO PMHNP, FNP
Nurse Practitioner (Psychiatric/Mental Health)
4400 NE HALSEY ST, BLDG 1, STE 200
PORTLAND, OR 97213
Multnomah County (503) 215-6556
DR. MATHEW SCOTT GREENBERG MD
Pathology (Anatomic Pathology & Clinical Pathology)
4400 NE HALSEY ST, BLDG #3 PATHOLOGY AND LABORATORY
PORTLAND, OR 97213
Multnomah County (503) 893-7757
DR. KRISTIAN NAVICKAS PHARMD
Pharmacist
4400 NE HALSEY ST, BUILDING 2, FOURTH FLOOR
PORTLAND, OR 97213
Multnomah County (503) 893-6900

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Providence Health & Service - Oregon's NPI number?

The NPI number for Providence Health & Service - Oregon is 1023738424. It was assigned to this organization in the NPPES registry on August 29, 2022. The provider is doing business as Providence ElderPlace - Portland.

Where is Providence Health & Service - Oregon located?

Providence Health & Service - Oregon is located at 4400 NE Halsey St Building 1, Ste 200, Portland, OR 97213. The listed phone number is (503) 215-6556.

What is Providence Health & Service - Oregon's specialty?

The primary specialty registered for this NPI is Program of All-Inclusive Care for the Elderly (PACE) Provider Organization with taxonomy code 251T00000X.

When was this NPI record last updated?

The NPPES record for Providence Health & Service - Oregon was last updated on May 16, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.