PROVIDENCE HEALTH & SERVICES - OREGON
NPI 1053419218
Family Medicine in Gresham, OR

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

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Active since September 20, 2006

440 NW DIVISION ST, GRESHAM, OR 97030(503) 215-9500(503) 215-9525 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, Jun 19, 2024, Aug 31, 2023 and 1 more (4 updates tracked since 2020).

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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 1053419218), doing business as Providence Medical Group, is a healthcare organization registered as a family medicine in Gresham, Oregon and active in the NPI registry since September 2006. The organization maintains a secondary practice location in Portland and lists Donald W Anderson, Asst Sec Enroll, as its authorized official.

NPPES Registry Identity

NPI1053419218

Entity TypeOrganization

Primary Taxonomy207Q00000X

Legal Business NamePROVIDENCE HEALTH & SERVICES - OREGON

Location Address440 NW DIVISION STGresham, OR 97030-5506

Mailing AddressPo Box 31001 - 4180Pasadena, CA 91110-4180 · (503) 215-6494 · Fax (503) 215-6644

Phone(503) 215-9500

Fax(503) 215-9525

Organization SubpartNo

Authorized OfficialDonald W AndersonAsst Sec Enroll · (425) 358-9786

Enumeration DateSeptember 20, 2006

Last NPPES UpdateJune 20, 20254 updates tracked since enumeration

NPPES CertifiedJune 20, 2025

✔ NPI 1053419218 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

Definition

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.

Also ListedInternal Medicine · Endocrinology, Diabetes & MetabolismTaxonomy 207RE0101X

Also ListedClinic/CenterTaxonomy 261Q00000X

440 NW DIVISION ST, Gresham, OR 97030

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Other Names 1

Doing Business AsProvidence Medical Group

Secondary Practice Location 1

Location 15211 NE Glisan St Bldg CPortland, OR 97213-3052 · Phone (503) 215-6601

Other Identifiers 1

Medicaid287333OR

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

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Providence Health Plan.Insurance ›

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.

KATIE L KETTERLING-THORNBURG APRN, FNP-C

Nurse Practitioner (Family)