PROVIDENCE HEALTH & SERVICES - OREGON
NPI 1205937273
Family Medicine in Lake Oswego, OR

Q: What is the provider's specialty?

The provider's specialty is Family Medicine with taxonomy code 207Q00000X.

Active since September 25, 2006

4004 KRUSE WAY PL STE 300, LAKE OSWEGO, OR 97035(503) 216-1500 Get Directions Write a Review

NPPES record last updated: July 4, 2025. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Jul 4, 2025, May 16, 2025, Jun 10, 2024 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 1205937273), doing business as Providence Medical Group, is a healthcare organization registered as a family medicine in Lake Oswego, Oregon and active in the NPI registry since September 2006. The organization lists Donald Wayne Anderson, Assistant Secreatry For Enrollment, as its authorized official.

NPPES Registry Identity

NPI1205937273

Entity TypeOrganization

Primary Taxonomy207Q00000X

Legal Business NamePROVIDENCE HEALTH & SERVICES - OREGON

Location Address4004 KRUSE WAY PL STE 300Lake Oswego, OR 97035-2479

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

Phone(503) 216-1500

Organization SubpartNo

Authorized OfficialDonald Wayne AndersonAssistant Secreatry For Enrollment · (425) 358-9786

Enumeration DateSeptember 25, 2006

Last NPPES UpdateJuly 4, 20254 updates tracked since enumeration

NPPES CertifiedJuly 4, 2025

✔ NPI 1205937273 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 ListedPhysical TherapistTaxonomy 225100000X

Also ListedClinic/CenterTaxonomy 261Q00000X

4004 KRUSE WAY PL STE 300, Lake Oswego, OR 97035

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Other Names 2

Doing Business AsProvidence Medical Group

Doing Business AsProvidence Medical Group Mercantile

Other Identifiers 1

Medicaid241291OR

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.

JOEL BENJAMIN WILLIAMS PT

Physical Therapist