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PROVIDENCE HEALTH & SERVICES OREGON
NPI 1104097906
Pediatrics in Longview, WA

Active since March 19, 2008
971 11TH AVE, LONGVIEW, WA 98632(360) 577-1771 Get Directions Write a Review

NPPES record last updated: June 20, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jun 20, 2025, May 16, 2025, Nov 13, 2018 (3 updates tracked since 2018).

About Providence Health & Services Oregon NPPES

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

PROVIDENCE HEALTH & SERVICES OREGON (NPI 1104097906), doing business as Prov Peds Neurology Longview, is a healthcare organization registered as a pediatrics in Longview, Washington and active in the NPI registry since March 2008. The organization lists Donald Wayne Anderson, Assistant Secretary Of Enrollments, as its authorized official.

NPPES Registry Identity

NPI1104097906
Entity TypeOrganization
Primary Taxonomy208000000X
Legal Business NamePROVIDENCE HEALTH & SERVICES OREGON
Location Address971 11TH AVELongview, WA 98632-2503
Mailing AddressPo Box 31001 - 4180Pasadena, CA 91110-4180 · (503) 215-6494
Phone(360) 577-1771
Organization SubpartYesParent: Providence Health & Services - Oregon
Authorized OfficialDonald Wayne AndersonAssistant Secretary Of Enrollments · (425) 358-9786
Enumeration DateMarch 19, 2008
Last NPPES UpdateJune 20, 20253 updates tracked since enumeration
NPPES CertifiedJune 20, 2025
✔ NPI 1104097906 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
Definition
A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.
Also ListedClinic/CenterTaxonomy 261Q00000X
971 11TH AVE, Longview, WA 98632
Open in Google Maps ↗

Other Names 2

Doing Business AsProv Peds Neurology Longview
Doing Business AsProvidence Medical Group

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Providence Health & Services Oregon is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

1,560

Medicare enrollment records show 1,560 clinicians reassign Medicare billing to Providence Health & Services Oregon, which bills Medicare for the services they deliver. Of these, 1 practice within 10 miles. Listed here are the 20 practicing nearest to this location.

Clinicians by Medicare Specialty 56

Internal Medicine251
Family Practice213
Nurse Practitioner210
Hospitalist102
Neurology91
Obstetrics/Gynecology57
Physical Therapist in Private Practice54
Psychiatry54
48 other specialties528

Nearest to this location (20)

See all 1,560
Muhammad Riaz, M.D
Family Practice
NPI 1053610493
1615 DELAWARE ST
Longview, WA 98632
(360) 414-7800
✔ PECOS✔ Accepts Medicare0.3 mi
Carol Opheikens, FNP-C
Nurse Practitioner
NPI 1053732677
401 SW BELAIR DR
Clatskanie, OR 97016
(503) 728-5088
✔ PECOS✔ Accepts Medicare13 mi
Joseph Freeburg, M.D.
Neurology
NPI 1174898381
2211 NE 139TH ST STE 3E120
Vancouver, WA 98686
(360) 487-5342
✔ PECOS✔ Accepts Medicare32 mi
Virginia Kelly, M.D.
Obstetrics/Gynecology
NPI 1043324270
2211 NE 139TH ST
Vancouver, WA 98686
(360) 487-1000
✔ PECOS✔ Accepts Medicare32 mi
Hyung Kim, M.D.
Internal Medicine
NPI 1992970206
2211 NE 139TH ST
Vancouver, WA 98686
(503) 413-8407
✔ PECOS✔ Accepts Medicare32 mi
Tula Top, M.D.
Hospice/Palliative Care
NPI 1346432721
2211 NE 139TH ST
Vancouver, WA 98686
(360) 487-1169
✔ PECOS✔ Accepts Medicare32 mi
Son Do, M.D.
Gastroenterology
NPI 1285668822
2415 NE 134TH ST SUITE 205
Vancouver, WA 98686
(360) 576-5060
✔ PECOS✔ Accepts Medicare32 mi
Maria Marin
Family Practice
NPI 1770276198
100 E 33RD ST STE 100
Vancouver, WA 98663
(360) 514-7556
✔ PECOS✔ Accepts Medicare36 mi
Justine Blaud, RN, CNM
Certified Nurse Midwife (CNM)
NPI 1770012403
2018 GRAND BLVD
Vancouver, WA 98661
(360) 852-9092
✔ PECOS✔ Accepts Medicare37 mi
Ragnar Scott, PMHNP
Nurse Practitioner
NPI 1780403915
400 E EVERGREEN BLVD STE 217
Vancouver, WA 98660
(509) 596-1138
✔ PECOS37 mi
Maryann Ogden, M.D.
Hospitalist
NPI 1811131261
7101 NE 137TH AVE
Vancouver, WA 98682
(360) 418-6000
✔ PECOS✔ Accepts Medicare37 mi
Cynthia Easley, RD, LD, CDE
Registered Dietitian or Nutrition Professional
NPI 1295074938
700 NE 87TH AVE
Vancouver, WA 98664
(360) 882-2778
39 mi
Katerina Erokhina, D.O.
Medical Oncology
NPI 1437404571
505 NE 87TH AVE STE 320
Vancouver, WA 98664
(360) 514-2550
✔ PECOS✔ Accepts Medicare39 mi
Khaled Pharaon, MD
General Surgery
NPI 1902090061
505 NE 87TH AVE SUITE 301
Vancouver, WA 98664
(360) 514-1854
✔ PECOS✔ Accepts Medicare39 mi
Kristen Thurman-Hanson, PSYD
Clinical Psychologist
NPI 1841725223
15640 NW LAIDLAW RD STE 102
Portland, OR 97229
(503) 764-0100
✔ PECOS✔ Accepts Medicare40 mi
Mini Zhang, M.D.
Psychiatry
NPI 1316238603
5 CENTERPOINTE DR STE 320
Lake Oswego, OR 97035
(971) 213-2837
✔ PECOS40 mi
Erica Hadley, MD
Pediatric Medicine
NPI 1134534928
10060 NE EVERGREEN PKWY
Hillsboro, OR 97124
(800) 813-2000
✔ PECOS41 mi
Kelly Myers Sugahara, LCSW
Clinical Social Worker
NPI 1740586601
3530 NE AINSWORTH ST
Portland, OR 97211
(541) 678-3645
✔ PECOS42 mi
Nagendra Tirumali, M.D.
Hematology/Oncology
NPI 1669565230
3600 N INTERSTATE AVE
Portland, OR 97227
(503) 331-6545
✔ PECOS✔ Accepts Medicare42 mi
Eric Chang, MD
Infectious Disease
NPI 1720290190
2801 N GANTENBEIN AVE RM 4117
Portland, OR 97227
(503) 413-6807
✔ PECOS✔ Accepts Medicare43 mi
See all 1,560 clinicians

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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 1104097906. It was assigned to this organization in the NPPES registry on March 19, 2008. The provider is doing business as Prov Peds Neurology Longview and Providence Medical Group.

Where is Providence Health & Services Oregon located?

Providence Health & Services Oregon is located at 971 11th Ave, Longview, WA 98632. The listed phone number is (360) 577-1771.

What is Providence Health & Services Oregon's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Is Providence Health & Services Oregon enrolled in Medicare?

Yes. Providence Health & Services Oregon is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Providence Health & Services Oregon?

According to the CMS Revalidation Reassignment List (October 2026 release), 1,560 clinicians in 56 Medicare specialties reassign their Medicare billing to Providence Health & Services Oregon. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Internal Medicine (251), Family Practice (213) and Nurse Practitioner (210). Of these, 1 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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 16 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.