PROVIDENCE HEALTH & SERVICES - OREGON
NPI 1083714141
Dermatology in Portland, OR

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

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

Active since September 25, 2006

417 SW 117TH AVE, 2ND FLOOR, PORTLAND, OR 97225(503) 216-9400(503) 216-9499 Get Directions Write a Review

NPPES record last updated: June 20, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jun 20, 2025, May 5, 2025, Sep 24, 2020 (3 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 1083714141), doing business as Providence Medical Group, is a healthcare organization registered as a dermatology in Portland, Oregon and active in the NPI registry since September 2006. The organization lists Donald W Anderson, Asst Sec Enroll, as its authorized official.

NPPES Registry Identity

NPI1083714141

Entity TypeOrganization

Primary Taxonomy207N00000X

Legal Business NamePROVIDENCE HEALTH & SERVICES - OREGON

Location Address417 SW 117TH AVE, 2ND FLOORPortland, OR 97225-5924

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

Phone(503) 216-9400

Fax(503) 216-9499

Organization SubpartNo

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

Enumeration DateSeptember 25, 2006

Last NPPES UpdateJune 20, 20253 updates tracked since enumeration

NPPES CertifiedJune 20, 2025

✔ NPI 1083714141 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians

Taxonomy Code207N00000X

Definition

A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.

Also ListedClinic/CenterTaxonomy 261Q00000X

417 SW 117TH AVE, Portland, OR 97225

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Other Names 2

Doing Business AsProvidence Medical Group

Doing Business AsProvidence Medical Group Sunset

Other Identifiers 1

Medicaid065003OR

Accepted Insurance

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

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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.

YVONNE HOWELL PA-C

Physician Assistant

417 SW 117TH AVE, SUITE 200
PORTLAND, OR 97225

Washington County (503) 216-9400

LISA S TURNER MD

Dermatology

417 SW 117TH AVE, 2ND FLOOR
PORTLAND, OR 97225

Washington County (503) 216-9400

VIEN THAO LUU MD

Internal Medicine

417 SW 117TH AVE, 2ND FLOOR
PORTLAND, OR 97225

Washington County (503) 216-9400

MICHAEL R. MCCLUNG MD

Clinic/Center (Medical Specialty)

417 SW 117TH AVE, STE. 120
PORTLAND, OR 97225

Washington County (503) 641-7173

MICHELLE D BONTA MD

Dermatology

417 SW 117TH AVE, 2ND FLOOR
PORTLAND, OR 97225

Washington County (503) 216-9400

JEAN D LEE MD

Internal Medicine

417 SW 117TH AVE, 2ND FLOOR
PORTLAND, OR 97225

Washington County (503) 216-9400

CONNIE VOLPI PA-C

Physician Assistant

417 SW 117TH AVE, 2ND FLOOR
PORTLAND, OR 97225

Washington County (503) 216-9400

MR. JONATHAN RYAN FORDYCE FNP-C

Nurse Practitioner (Family)

417 SW 117TH AVE
PORTLAND, OR 97225

Washington County (503) 216-8980

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 & Services - Oregon's NPI number?

The NPI number for Providence Health & Services - Oregon is 1083714141. It was assigned to this organization in the NPPES registry on September 25, 2006. The provider is doing business as Providence Medical Group and Providence Medical Group Sunset.

Where is Providence Health & Services - Oregon located?

Providence Health & Services - Oregon is located at 417 SW 117th Ave 2nd Floor, Portland, OR 97225. The listed phone number is (503) 216-9400.

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

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

What insurance does Providence Health & Services - Oregon accept?

Health plans from Providence Health Plan list Providence Health & Services - Oregon as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Providence Health & Services - Oregon was last updated on June 20, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 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.