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PROVIDENCE HEALTH & SERVICES - OREGON
NPI 1164522496
Family Medicine in Portland, OR

Active since September 25, 2006
4920 N INTERSTATE AVE, PORTLAND, OR 97217(503) 215-3300(503) 215-3350 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, Sep 24, 2020 (3 updates tracked since 2020).

About Providence Health & Services - Oregon NPPES

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

PROVIDENCE HEALTH & SERVICES - OREGON (NPI 1164522496), doing business as Providence Medical Group, is a healthcare organization registered as a family medicine in Portland, Oregon and active in the NPI registry since September 2006. The organization lists Donald Wayne Anderson, Assistant Secretary Of Enrollments, as its authorized official.

NPPES Registry Identity

NPI1164522496
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NamePROVIDENCE HEALTH & SERVICES - OREGON
Location Address4920 N INTERSTATE AVEPortland, OR 97217-3653
Mailing AddressPo Box 31001 - 4180Pasadena, CA 91110-4180 · (503) 215-6494 · Fax (503) 215-6644
Phone(503) 215-3300
Fax(503) 215-3350
Organization SubpartNo
Authorized OfficialDonald Wayne AndersonAssistant Secretary Of Enrollments · (425) 358-9786
Enumeration DateSeptember 25, 2006
Last NPPES UpdateJune 20, 20253 updates tracked since enumeration
NPPES CertifiedJune 20, 2025
✔ NPI 1164522496 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ 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 ListedClinic/CenterTaxonomy 261Q00000X
4920 N INTERSTATE AVE, Portland, OR 97217
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Other Names 2

Doing Business AsProvidence Medical Group
Doing Business AsProvidence Medical Group North Portland Family & Community Medicine

Other Identifiers 1

Medicaid022845OR

Accepted Insurance

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

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

1,498

Medicare enrollment records show 1,498 clinicians reassign Medicare billing to Providence Health & Services - Oregon, which bills Medicare for the services they deliver. Of these, 12 practice at this address and 1,050 within 10 miles. Listed here are the 20 practicing nearest to this location.

Clinicians by Medicare Specialty 56

Internal Medicine250
Family Practice212
Nurse Practitioner210
Hospitalist96
Neurology57
Obstetrics/Gynecology57
Physical Therapist in Private Practice54
Clinical Psychologist53
48 other specialties509

Nearest to this location (20)

See all 1,498
Amelia Baker, MD, PHD
Family Practice
NPI 1144649179
4920 N INTERSTATE AVE
Portland, OR 97217
(503) 215-3300
✔ PECOS✔ Accepts MedicareSame address
Melissa Boucher, DO
Family Practice
NPI 1386222495
4920 N INTERSTATE AVE
Portland, OR 97217
(503) 215-3300
✔ PECOS✔ Accepts MedicareSame address
Matthew Breeze, MD
Family Practice
NPI 1083655609
4920 N INTERSTATE AVE
Portland, OR 97217
(503) 215-3000
✔ PECOS✔ Accepts MedicareSame address
Zhong Chen, MD
Family Practice
NPI 1518609767
4920 N INTERSTATE AVE
Portland, OR 97217
(503) 215-3300
✔ PECOS✔ Accepts MedicareSame address
Amber Choruby Whiteley, PHD
Clinical Psychologist
NPI 1952284713
4920 N INTERSTATE AVE
Portland, OR 97217
(503) 215-3300
✔ PECOS✔ Accepts MedicareSame address
Shauna Ensminger, MD
Family Practice
NPI 1619960002
4920 N. INTERSTATE AVENUE
Portland, OR 97217
(503) 215-3300
✔ PECOS✔ Accepts MedicareSame address
Mai'ana Feuerborn, MD
Family Practice
NPI 1861134017
4920 N INTERSTATE AVE
Portland, OR 97217
(503) 215-3300
✔ PECOS✔ Accepts MedicareSame address
Mischa Ronick, MD
Family Practice
NPI 1780977371
4920 N INTERSTATE AVE
Portland, OR 97217
(503) 215-3300
✔ PECOS✔ Accepts MedicareSame address
Roxanne Thomas, MD
Family Practice
NPI 1578099859
4920 N INTERSTATE AVE
Portland, OR 97217
(503) 215-3300
✔ PECOS✔ Accepts MedicareSame address
Kimberly Wehbe, FNP
Nurse Practitioner
NPI 1477586097
4920 N INTERSTATE AVE
Portland, OR 97217
(503) 215-3300
✔ PECOS✔ Accepts MedicareSame address
Sylvia Peterson-Perry, MD
Family Practice
NPI 1336522747
4920 N INTERSTATE AVE
Portland, OR 97217
(503) 215-3300
✔ PECOS✔ Accepts MedicareSame address
John Yates, MD
Family Practice
NPI 1295224392
4920 N INTERSTATE AVE
Portland, OR 97217
(503) 215-3300
✔ PECOS✔ Accepts MedicareSame address
Kori Anderson, FNP
Nurse Practitioner
NPI 1043479389
4340 N INTERSTATE AVE
Portland, OR 97217
(503) 215-1444
✔ PECOS✔ Accepts Medicare0.3 mi
Nagendra Tirumali, M.D.
Hematology/Oncology
NPI 1669565230
3600 N INTERSTATE AVE
Portland, OR 97227
(503) 331-6545
✔ PECOS✔ Accepts Medicare0.7 mi
Ann Scott, M.D.
Obstetrics/Gynecology
NPI 1871678565
3550 N INTERSTATE AVE
Portland, OR 97227
(503) 331-6142
✔ PECOS✔ Accepts Medicare0.8 mi
Hsiao Chi Wu, MD
Family Practice
NPI 1194713313
4709 N LAGOON AVE
Portland, OR 97217
(877) 685-5886
✔ PECOS1.0 mi
Eric Chang, MD
Infectious Disease
NPI 1720290190
2801 N GANTENBEIN AVE RM 4117
Portland, OR 97227
(503) 413-6807
✔ PECOS✔ Accepts Medicare1.2 mi
Karin Selva, MD
Endocrinology
NPI 1003883026
501 N GRAHAM ST SUITE 375
Portland, OR 97227
(503) 413-1600
✔ PECOS1.2 mi
Mubeen Jafri, MD
General Surgery
NPI 1245433184
501 N GRAHAM ST SUITE 300
Portland, OR 97227
(503) 460-0065
✔ PECOS1.2 mi
Karen Archabald, MD
Obstetrics/Gynecology
NPI 1144486507
300 N GRAHAM ST STE 100
Portland, OR 97227
(503) 413-1122
✔ PECOS✔ Accepts Medicare1.3 mi
See all 1,498 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 1164522496. 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 North Portland Family & Community Medicine.

Where is Providence Health & Services - Oregon located?

Providence Health & Services - Oregon is located at 4920 N Interstate Ave, Portland, OR 97217. The listed phone number is (503) 215-3300.

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

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

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), 1,498 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 (250), Family Practice (212) and Nurse Practitioner (210). Of these, 12 practice at this address and 1,050 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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 15 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.