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CEDAR CREEK INTERNAL MEDICINE,PC
NPI 1265517437
Internal Medicine in Portland, OR

Active since October 26, 2006CLIA 38D1069788 · Waiver
10200 SW EASTRIDGE ST, STE 205, PORTLAND, OR 97225(503) 280-4555(503) 280-4559 Get Directions Write a Review

NPPES record last updated: November 13, 2012. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Cedar Creek Internal Medicine,pc NPPES

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

CEDAR CREEK INTERNAL MEDICINE,PC (NPI 1265517437) is a healthcare organization registered as an internal medicine in Portland, Oregon and active in the NPI registry since October 2006. The organization holds a CLIA Waiver certificate valid through June 12, 2027 and lists Bradley J Fancher, President, as its authorized official.

NPPES Registry Identity

NPI1265517437
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameCEDAR CREEK INTERNAL MEDICINE,PC
Location Address10200 SW EASTRIDGE ST, STE 205Portland, OR 97225-5064
Mailing Address10200 Sw Eastridge St, Ste 205Portland, OR 97225-5064 · (503) 280-4555 · Fax (503) 280-4559
Phone(503) 280-4555
Fax(503) 280-4559
Organization SubpartNo
Authorized OfficialBradley J FancherPresident · (503) 280-4555
Enumeration DateOctober 26, 2006
Last NPPES UpdateNovember 13, 2012
✔ NPI 1265517437 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
10200 SW EASTRIDGE ST, Portland, OR 97225
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Other Identifiers 1

Medicare ID-Type Unspecified108054OR · Group Number

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Moda Health Plan, Inc..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)

Cedar Creek Internal Medicine,pc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Cedar Creek Internal Medicine,pc, which bills Medicare for the services this clinician delivers.

Clinician (1)

Duc Nguyen, DO
Internal Medicine
NPI 1275565814
10200 SW EASTRIDGE ST SUITE 205
Portland, OR 97225
(503) 280-4555
✔ PECOS✔ Accepts MedicareSame address

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

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 38D1069788

Cedar Creek Internal Medicine PC · Portland, OR
Active · expires Jun 12, 2027
CLIA Number38D1069788
Laboratory TypePhysician Office
Certificate Effective DateJune 13, 2025
Certificate Expiration DateJune 12, 2027
Laboratory DirectorBradley J Fancher MD
Laboratory Phone(503) 280-4555
Laboratory LocationCedar Creek Internal Medicine PC10200 SW Eastridge St Suite 205, Portland, OR 97225
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

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 Cedar Creek Internal Medicine,pc's NPI number?

The NPI number for Cedar Creek Internal Medicine,pc is 1265517437. It was assigned to this organization in the NPPES registry on October 26, 2006.

Where is Cedar Creek Internal Medicine,pc located?

Cedar Creek Internal Medicine,pc is located at 10200 SW Eastridge St Ste 205, Portland, OR 97225. The listed phone number is (503) 280-4555.

What is Cedar Creek Internal Medicine,pc's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Cedar Creek Internal Medicine,pc enrolled in Medicare?

Yes. Cedar Creek Internal Medicine,pc is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Cedar Creek Internal Medicine,pc?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Internal Medicine) reassigns their Medicare billing to Cedar Creek Internal Medicine,pc. 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. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Cedar Creek Internal Medicine,pc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 38D1069788) is associated with this NPI, valid through June 12, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Cedar Creek Internal Medicine,pc accept?

Health plans from Moda Health Plan, Inc. list Cedar Creek Internal Medicine,pc 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 Cedar Creek Internal Medicine,pc was last updated on November 13, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 years 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.