EAST PAVILION SURGERY CENTER
NPI 1316449168
Clinic/Center - Ambulatory Surgical in Portland, OR

Active since March 07, 2018CLIA 38D2166408 · Waiver
9135 SW BARNES RD STE 161, PORTLAND, OR 97225(971) 339-7791 Get Directions Write a Review

NPPES record last updated: July 16, 2019. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Jul 16, 2019, Aug 23, 2018, May 2, 2018 and 2 more (5 updates tracked since 2018).

  • Organization
  • Clinic/Center
  • Ambulatory Surgical
  • Accepts Insurance
  • CLIA Number: 38D2166408
  • CLIA Cert. Type: Ambulatory Surgery Center
  • CLIA Exp. Date: 05-15-2027

About EAST PAVILION SURGERY CENTER

This page provides the complete NPI Profile along with additional information for East Pavilion Surgery Center, a provider established in Portland, Oregon operating as a Clinic/center, focusing in ambulatory surgical . The healthcare provider is registered in the NPI registry with number 1316449168 assigned on March 2018. The practitioner's primary taxonomy code is 261QA1903X. The provider is registered as an organization and their NPI record was last updated 7 years ago. The provider's is doing business as East Pavilion Surgery Center. The authorized official of this NPI record is Mr. Bruce Dudley (Chief Administrative Officer)

NPI
1316449168 Verify this NPI
Provider Legal Name
SURGERY CENTER AT ST. VINCENT, LLC
Other Organization Name
EAST PAVILION SURGERY CENTER
Other Name Type
Doing Business As (3)
Entity Type
Organization
Location Address
9135 SW BARNES RD STE 161 PORTLAND, OR 97225
Location Phone
(971) 339-7791
Mailing Address
9135 SW BARNES RD STE 161 PORTLAND, OR 97225
Mailing Phone
(971) 339-7791
Is Sole Proprietor?
No
Is Organization Subpart?
No
Enumeration Date
03-07-2018
Last Update Date
07-16-2019
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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

Clinic/Center Ambulatory Surgical

Taxonomy Code
261QA1903X
Type
Ambulatory Health Care Facilities

Insurance Plans Accepted

According to publicly available information the provider might be accepting the following health plans from these health insurance companies:

  • KP OR Bronze 6000 - EPO
  • KP OR Bronze HSA 7100 - EPO
  • KP OR Gold 0 - EPO
  • KP OR Gold 1750 - EPO
  • KP OR Silver 3000 - EPO
  • KP OR Silver 4000 - EPO
  • KP Oregon Standard Bronze Plan - EPO
  • KP Oregon Standard Gold Plan - EPO
  • KP Oregon Standard Silver Plan - EPO
  • KP OR Family Dental - $100 Ded - EPO
  • KP OR Family Dental - $1000 - EPO
  • KP OR Family Dental - $1000/$50 Ded - EPO
  • 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

*Please verify directly with this provider to make sure your insurance plan is currently accepted.

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name

MR. BRUCE DUDLEY

Authorized Official Title
CHIEF ADMINISTRATIVE OFFICER
Authorized Official Phone
(971) 339-7791

Areas of Expertise

The following services and procedures, recently provided to Medicare patients, illustrate the range of care this provider offers. This list reflects the variety of services available to all patients visiting the practice and is based on 2022 Medicare dataset. In general, the more frequently a provider treats specific conditions or performs particular procedures, the more experienced they become in addressing similar patient needs. The provider has delivered many of the services listed below to Medicare patients. Please note that this list does not include services provided to patients who are not covered by Medicare.

Crushing of stone of ureter with insertion of stent using an endoscope

This procedure involves using a thin, flexible tube (endoscope) to locate and break down kidney stones in the ureter. After this, a small tube (stent) is inserted to help maintain an open pathway for urine to flow.

This service was performed 46 times for 41 patients

Destruction and/or removal of growth of bladder and urethra using an endoscope, 2.0-5.0 cm

This procedure involves using a thin, flexible tool called an endoscope to examine and remove a growth in your bladder and urethra. The growth size ranges from 2.0-5.0 cm. This is done to ensure your urinary system functions properly.

This service was performed 27 times for 23 patients

Exam of nose and sinus with removal of nasal sinus using an endoscope

This procedure involves using an endoscope, a thin tube with a light and camera, to examine your nose and sinuses. If necessary, unwanted tissue from the nasal sinus is removed. This can help improve breathing and alleviate sinus issues.

This service was performed 22 times for 14 patients

Exploration of nasal sinus using an endoscope

Exploration of the nasal sinus using an endoscope is a procedure where a thin, flexible tube with a light and camera attached is inserted into the nose. This allows the doctor to view and examine the sinuses in detail, aiding in the diagnosis and treatment of sinus issues.

This service was performed 33 times for 19 patients

Imaging of urinary tract following injection of a contrast agent

This procedure involves injecting a contrast agent into your body to help highlight the urinary tract during imaging. The contrast agent makes your urinary tract more visible on the images, providing detailed information about its structure and function. This can help in diagnosing any potential issues.

This service was performed 43 times for 38 patients

Incision of nasal sinus using an endoscope

This procedure, called endoscopic sinus surgery, involves using a thin, flexible tube with a light and camera on the end, known as an endoscope. It's inserted into the nasal passages to view and remove obstructions in the sinuses, helping to alleviate symptoms.

This service was performed 21 times for 14 patients

Insertion of stent in ureter using an endoscope

This procedure involves placing a small, flexible tube (stent) in your body's drainage system to help urine flow from the kidneys to the bladder. An endoscope, a thin tube with a light and camera, is used for precise placement.

This service was performed 20 times for 18 patients

Insertion or replacement of spinal neurostimulator generator or receiver

The insertion of a spinal neurostimulator generator or receiver is a procedure to manage chronic pain. A small device is implanted under your skin, which sends mild electrical signals to your spinal cord. These signals disrupt pain signals, helping to reduce discomfort.

This service was performed 11 times for 11 patients

Partial removal of breast

A partial removal of the breast, also known as a lumpectomy, involves taking out a portion of the breast tissue to eliminate concerning cells. It's typically performed when the problem area is limited in size. This procedure helps to preserve most of the breast's appearance while aiming to remove all the unhealthy cells.

This service was performed 21 times for 20 patients

Removal of nasal air passage under lining tissue

This procedure, often done to improve breathing or address sinus issues, involves the removal of tissue from the lining of the nasal air passage. It's performed under anesthesia and recovery time varies based on individual health status.

This service was performed 62 times for 31 patients

Removal of prostate gland using an electrocautery knife through urethra with control of bleeding using an endoscope

This procedure involves the careful removal of a small gland located in the lower body using a special heated knife, inserted through a natural body passage. An endoscope, a thin tube with a light and camera, helps to manage any bleeding. The aim is to alleviate discomfort and improve overall health.

This service was performed 55 times for 55 patients

Removal of spine bone for insertion of neurostimulator electrode plate in spine

This procedure involves removing a small part of the spine bone to place a neurostimulator electrode plate. This device can help manage pain signals from the spine to the brain, improving comfort and quality of life. The process is performed by skilled surgeons in a safe environment.

This service was performed 11 times for 11 patients

Repair of groin hernia (5 years or older)

Repair of a groin hernia is a procedure aimed at fixing an abnormal bulge that can occur in the area between your abdomen and thigh. This condition happens when tissue pushes through a weak spot in your lower abdominal wall. The repair procedure returns this tissue back to its proper place.

This service was performed 21 times for 20 patients

Repair of nasal passage

Repair of the nasal passage is a surgical procedure aimed at correcting problems in your nose that cause difficulty in breathing or other discomforts. It can address issues like a deviated septum, nasal polyps, or chronic sinusitis. The goal is to improve your quality of life.

This service was performed 13 times for 12 patients

Reshaping of nasal cartilage

Reshaping of nasal cartilage, also known as rhinoplasty, is a surgical procedure to modify the structure of the nose for aesthetic or functional purposes. It involves adjusting the cartilage and bone in the nose to achieve the desired shape or to improve breathing.

This service was performed 30 times for 29 patients

Shock wave crushing of kidney stones

Shock wave crushing of kidney stones, also known as Extracorporeal Shock Wave Lithotripsy (ESWL), is a non-invasive treatment. It involves the use of sound waves to break down kidney stones into small pieces that can easily pass through your urinary tract.

This service was performed 16 times for 16 patients

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
38D2166408
Facility Type
Ambulatory Surgery Center
Certificate Effective Date
May 16, 2025
Certificate Expiration Date
May 15, 2027
Laboratory Director
ANAND JAIN
Certificate Type
Certificate of Waiver
Certificate Type Description
This CLIA certificate is issued to East Pavilion Surgery Center 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.

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Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1316449168, enumerated as an "organization" on March 07, 2018.

The provider is located at 9135 SW BARNES RD STE 161 PORTLAND, OR 97225 and the phone number is (971) 339-7791.

Clinic/Center with taxonomy code 261QA1903X and a focus in Ambulatory Surgical.

The provider might be accepting Accepts: Kaiser Permanente and Providence Health Plan. Please consult your insurance carrier or call the provider to verify.