1. Home
  2. Directory
  3. Oregon
  4. Portland
  5. Internal Medicine
  6. NPI Profile

FANNO CREEK CLINIC LLC
NPI 1609876705
Internal Medicine in Portland, OR

Active since July 29, 2005CLIA 38D0927861 · Certificate of Compliance
2400 SW VERMONT ST, PORTLAND, OR 97219(503) 452-0915(503) 768-9232 Get Directions Write a Review

NPPES record last updated: October 16, 2007. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Fanno Creek Clinic Llc NPPES

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

FANNO CREEK CLINIC LLC (NPI 1609876705) is a healthcare organization registered as an internal medicine in Portland, Oregon and active in the NPI registry since July 2005. The organization holds a CLIA Certificate of Compliance certificate valid through October 17, 2027 and lists Larry M Reed, Clinic Manager, as its authorized official.

NPPES Registry Identity

NPI1609876705
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameFANNO CREEK CLINIC LLC
Location Address2400 SW VERMONT STPortland, OR 97219-1940
Mailing Address2400 Sw Vermont StPortland, OR 97219-1940 · (503) 452-0915 · Fax (503) 768-9232
Phone(503) 452-0915
Fax(503) 768-9232
Organization SubpartNo
Authorized OfficialLarry M ReedClinic Manager · (503) 452-0915
Enumeration DateJuly 29, 2005
Last NPPES UpdateOctober 16, 2007
✔ NPI 1609876705 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
License✔ Licensed in OR · 2802
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.
2400 SW VERMONT ST, Portland, OR 97219
Open in Google Maps ↗

Other Identifiers 2

Medicare PINR0000WFBZBOR
Medicaid151070OR

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., Providence Health Plan.Insurance ›

CLIA Laboratory Certificates CMS CLIA 2

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 Compliance 38D0927861

Fanno Creek Clinic LLC Laboratory · Portland, OR
Active · expires Oct 17, 2027
CLIA Number38D0927861
Laboratory TypePhysician Office
Certificate Effective DateOctober 18, 2025
Certificate Expiration DateOctober 17, 2027
Laboratory DirectorBarry D. Albertson
Laboratory Phone(503) 452-0915
Laboratory LocationFanno Creek Clinic LLC Laboratory2400 SW Vermont St, Portland, OR 97219
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Certificate of Waiver 38D2117186

Fanno Creek Clinical Research Lab · Portland, OR
Expired · Aug 9, 2026
CLIA Number38D2117186
Laboratory TypePhysician Office
Certificate Effective DateAugust 10, 2024
Certificate Expiration DateAugust 9, 2026
Laboratory DirectorBarry D Albertson Phd
Laboratory Phone(503) 452-0915
Laboratory LocationFanno Creek Clinical Research Lab2400 SW Vermont Street, Portland, OR 97219
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

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.

DR. SUSAN YEH MD
Internal Medicine
2400 SW VERMONT ST
PORTLAND, OR 97219
Multnomah County (503) 452-0915
MARCIA M KERENSKY MD
Internal Medicine
2400 SW VERMONT ST
PORTLAND, OR 97219
Multnomah County (503) 452-0915
DR. NICHOLAS ALOISIUS KUHN MD
Internal Medicine
2400 SW VERMONT ST
PORTLAND, OR 97219
Multnomah County (503) 452-0915
DR. RONALD SKLAR SKLAR M.D.
Pediatrics (Neonatal-Perinatal Medicine)
2400 SW VERMONT ST
PORTLAND, OR 97219
Multnomah County (503) 452-0915
GLORIA FRANDSEN L.C.S.W.
Social Worker (Clinical)
2400 SW VERMONT ST
PORTLAND, OR 97219
Multnomah County (503) 452-0915
JENNIFER YEAST D.O.
Internal Medicine
2400 SW VERMONT ST
PORTLAND, OR 97219
Multnomah County (503) 452-0915
GEORGE B DEMETRION MD
Internal Medicine
2400 SW VERMONT ST
PORTLAND, OR 97219
Multnomah County (503) 452-0915
CATHLEEN A FOLK FNP
Nurse Practitioner
2400 SW VERMONT ST
PORTLAND, OR 97219
Multnomah County (503) 452-0915

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 Fanno Creek Clinic LLC's NPI number?

The NPI number for Fanno Creek Clinic LLC is 1609876705. It was assigned to this organization in the NPPES registry on July 29, 2005.

Where is Fanno Creek Clinic LLC located?

Fanno Creek Clinic LLC is located at 2400 SW Vermont St, Portland, OR 97219. The listed phone number is (503) 452-0915.

What is Fanno Creek Clinic LLC's specialty?

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

Does Fanno Creek Clinic LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 38D0927861) is associated with this NPI, valid through October 17, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Fanno Creek Clinic LLC accept?

Health plans from Moda Health Plan, Inc. and Providence Health Plan list Fanno Creek Clinic LLC 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 Fanno Creek Clinic LLC was last updated on October 16, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 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.