FANNO CREEK CLINIC LLC
NPI 1609876705
Internal Medicine in Portland, OR
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
Specialties & Licenses
Other Identifiers 2
Group Practice 1
Accepted 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)
Fanno Creek Clinic Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
53Medicare enrollment records show 53 clinicians reassign Medicare billing to Fanno Creek Clinic LLC, which bills Medicare for the services they deliver. Of these, 14 practice at this address and 33 within 10 miles. Listed here are the 20 practicing nearest to this location.
Clinicians by Medicare Specialty 14
Nearest to this location (20)
See all 53Source: 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 Compliance 38D0927861
Fanno Creek Clinic LLC Laboratory · Portland, ORFrequently 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.
Is Fanno Creek Clinic LLC enrolled in Medicare?
Yes. Fanno Creek Clinic LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Fanno Creek Clinic LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 53 clinicians in 14 Medicare specialties reassign their Medicare billing to Fanno Creek Clinic LLC. 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. The largest specialties are Internal Medicine (17), Diagnostic Radiology (16) and Nurse Practitioner (6). Of these, 14 practice at this address and 33 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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 19 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.
# Fanno Creek Clinic Llc · NPI 1609876705
Internal Medicine organization in Portland, Oregon. Organization record, active in the CMS NPPES registry since July 29, 2005.
## Identity
- **NPI:** 1609876705 (Entity type: Organization)
- **Enumerated:** July 29, 2005
- **Primary specialty:** Internal Medicine · taxonomy 207R00000X
- **Organization subpart:** No
- **Authorized official:** Larry Reed, CLINIC MANAGER
## Practice location
- **Address:** 2400 SW VERMONT ST, Portland, OR 97219-1940
- **Phone:** (503) 452-0915 · **Fax:** (503) 768-9232
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 53 clinicians in 14 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Internal Medicine (17), Diagnostic Radiology (16), Nurse Practitioner (6); 14 practice at this address and 33 within 10 miles; [full list](https://npiprofile.com/npi/1609876705/clinicians) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** October 16, 2007
- **Other identifiers:** Medicare PIN R0000WFBZB (OR); Medicaid 151070 (OR)
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1609876705) · Data from the CMS NPPES public registry.