TANASBOURNE PLASTIC SURGERY PC
NPI 1174708457
Plastic Surgery in Portland, OR
NPI Status: Active since January 04, 2008
Contact Information
11790 SW BARNES RD STE 120
PORTLAND, OR
ZIP 97225
Phone: (503) 297-9340
Fax: (503) 200-5499
- Organization
- Plastic Surgery
- Accepts Insurance
- Medicare Supplier
- Accepts Medicare Approved Payment
- CLIA Number: 38D2059832
- CLIA Cert. Type: Practitioner Other
- CLIA Exp. Date: 07-10-2027
About TANASBOURNE PLASTIC SURGERY PC
This page provides the complete NPI Profile along with additional information for Tanasbourne Plastic Surgery Pc, a provider established in Portland, Oregon operating as a Plastic Surgery. The healthcare provider is registered in the NPI registry with number 1174708457 assigned on January 2008. The practitioner's primary taxonomy code is 208200000X with license number MD22413 (OR). The provider is registered as an organization and their NPI record was last updated one year ago. The organization operates as a Single Specialty Group with one or more individual practitioners, all of who practice with the same area of specialization. The provider's
- NPI
- 1174708457
- Provider Legal Name
- TANASBOURNE PLASTIC SURGERY PC
- Other Organization Name
- Other Name Type
- (6)
- Entity Type
- Organization
- Location Address
- 11790 SW BARNES RD STE 120 PORTLAND, OR 97225
- Location Phone
- (503) 297-9340
- Location Fax
- (503) 200-5499
- Mailing Address
- 11790 SW BARNES RD STE 120 PORTLAND, OR 97225
- Mailing Phone
- (503) 297-9340
- Mailing Fax
- (503) 200-5499
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 01-04-2008
- Last Update Date
- 05-13-2025
- Code Navigator
Tanasbourne Plastic Surgery Pc is a medicare supplier with PTAN 20641715 who accepts Medicare assignment for all durable medical equipment and supplies. The provider accepts the Medicare allowable as payment in full.The supplier carries the following product categories: Prosthetic Lenses: Conventional Eyeglasses or Prosthetic Lenses: Conventional Contact Lenses.
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Plastic Surgery
- Taxonomy Code
- 208200000X
- Type
- Allopathic & Osteopathic Physicians
- License No.
- MD22413
- License State
- OR
- Taxonomy Description
- A plastic surgeon deals with the repair, reconstruction or replacement of physical defects of form or function involving the skin, musculoskeletal system, craniomaxillofacial structures, hand, extremities, breast and trunk and external genitalia or cosmetic enhancement of these areas of the body. Cosmetic surgery is an essential component of plastic surgery. The plastic surgeon uses cosmetic surgical principles to both improve overall appearance and to optimize the outcome of reconstructive procedures. The surgeon uses aesthetic surgical principles not only to improve undesirable qualities of normal structures but in all reconstructive procedures as well.
Group Taxonomy 193400000X SINGLE SPECIALTY GROUP
This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- BridgeSpan Standard Bronze Plan - EPO
- BridgeSpan Standard Gold Plan - EPO
- BridgeSpan Standard Silver Plan - EPO
- Moda Health Affinity Bronze 8000 - EPO
- Moda Health Affinity Bronze 9000 - EPO
- Moda Health Affinity Bronze HDHP 7500 - EPO
- Moda Health Affinity Gold 1000 - EPO
- Moda Health Affinity Gold 1500 - EPO
- Moda Health Affinity Gold 250 - EPO
- Moda Health Affinity Silver 3000 - EPO
- Moda Health Affinity Silver 3400 - EPO
- Moda Health Affinity Silver 4500 - EPO
- Moda Health Affinity Silver 6000 - EPO
- Moda Health Oregon Standard Bronze Affinity - EPO
- Moda Health Oregon Standard Gold Affinity - EPO
- Moda Health Oregon Standard Silver Affinity - EPO
- Moda Select Alaska Bronze 6500 - PPO
- Moda Select Alaska Bronze HDHP 5500 - PPO
- Moda Select Alaska Gold 1500 - PPO
- Moda Select Alaska Silver 4500 - PPO
- Moda Select Alaska Standard Bronze - PPO
- Moda Select Alaska Standard Gold - PPO
- Moda Select Alaska Standard Silver - PPO
- Connect 1500 Gold - EPO
- Connect 6000 Silver - EPO
- Connect 9800 Bronze - EPO
- HSA Qualified 7500 Bronze - Choice Network - EPO
- HSA-E Qualified 7500 Bronze - Signature Network - EPO
- Providence Oregon Standard Bronze Plan - Choice Network - EPO
- Providence Oregon Standard Bronze Plan - Signature Network - EPO
- Providence Oregon Standard Gold Plan - Choice Network - EPO
- Providence Oregon Standard Gold Plan - Signature Network - EPO
- Providence Oregon Standard Silver Plan - Choice Network - EPO
- Providence Oregon Standard Silver Plan - Signature Network - EPO
- Bronze 8000 Individual Connect - EPO
- Bronze Essential 9000 With 4 Copay No Deductible Office Visits Individual Connect - EPO
- Bronze HSA 7000 Individual Connect - EPO
- Gold 2300 Individual Connect - EPO
- Regence Standard Bronze Plan Individual Connect - EPO
- Regence Standard Gold Plan Individual Connect - EPO
- Regence Standard Silver Plan Individual Connect - EPO
- Silver 6500 Individual Connect - EPO
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Medical Equipment Supplier
The provider carries the following medical supplies product categories:
- PTAN
- 20641715
- Accepts Medicare Assignment
- YES
- Specialities List
- Optician.
- Provider Type List
- PHYSICIAN – OPHTHALMOLOGY.
- Competitive Bidding
- NO
Supplies List
- Prosthetic Lenses: Conventional Eyeglasses - Conventional Eyeglasses
- Prosthetic Lenses: Conventional Contact Lenses - Conventional Contact Lenses
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 38D2059832
- Facility Type
- Practitioner Other
- Certificate Effective Date
- July 11, 2025
- Certificate Expiration Date
- July 10, 2027
- Laboratory Director
- NIPOON DAVE
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Tanasbourne Plastic Surgery Pc to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
Reviews for TANASBOURNE PLASTIC SURGERY PC
There are currently no reviews for this provider. Be the first person to share your experience with this provider by filling out our review form. Your insights are appreciated and will help others make informed decisions.
NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1174708457, we treat the final digit (7) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 53. The final step is to find the difference between that total and the next multiple of ten (60 - 53 = 7).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 53 is 60. The difference is the calculated check digit.
Other Providers at the Same Location
The following 2 providers are registered at the same or a nearby location.
PORTLAND, OR 97225
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1174708457, enumerated as an "organization" on January 04, 2008.
The provider is located at 11790 SW BARNES RD STE 120 PORTLAND, OR 97225 and the phone number is (503) 297-9340.
Plastic Surgery with taxonomy code 208200000X.
The provider might be accepting Accepts: BridgeSpan Health Company, Moda Health Plan, Inc.,. Please consult your insurance carrier or call the provider to verify.
