DR. SHAWN TIMOTHY PATRICK M.D.
NPI 1699769786
Internal Medicine - Cardiovascular Disease in Portland, OR

Q: What is Shawn Patrick's NPI number?

The NPI number for Shawn Patrick is 1699769786. It was assigned to this individual provider in the NPPES registry on September 6, 2005.

Q: What is Shawn Patrick's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Cardiovascular Disease, with taxonomy code 207RC0000X.

Q: When was this NPI record last updated?

The NPPES record for Shawn Patrick was last updated on August 16, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 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.

Active since September 06, 2005PECOS EnrolledAccepts Medicare Assignment

85.78/100

CMS Quality Rating

2222 NW LOVEJOY ST, SUITE 606, PORTLAND, OR 97210(503) 229-7554(503) 274-5400 Get Directions Write a Review

NPPES record last updated: August 16, 2018. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Aug 16, 2018, Mar 17, 2018, Sep 1, 2017 (3 updates tracked since 2017).

On this page

About Dr. Shawn Timothy Patrick M.d. NPPES

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

DR. SHAWN TIMOTHY PATRICK M.D. (NPI 1699769786) is an individual cardiovascular disease provider in Portland, Oregon, licensed in Oregon (MD22839) and active in the NPI registry since September 2005. He is enrolled in Medicare PECOS, is affiliated with Legacy Emanuel Medical Center, and maintains 4 additional practice locations.

NPPES Registry Identity

NPI1699769786

Entity TypeIndividualMale

Primary Taxonomy207RC0000X

Provider Legal NameDR. SHAWN TIMOTHY PATRICKCredential: M.D.

Location Address2222 NW LOVEJOY ST, SUITE 606Portland, OR 97210-3033

Mailing Address1040 Nw 22nd Ave, Ste 660Portland, OR 97210-3083 · (503) 413-7162

Phone(503) 229-7554

Fax(503) 274-5400

Sole ProprietorNo

Medical School CMSMedical College Of WisconsinGraduated 1994

Enumeration DateSeptember 6, 2005

Last NPPES UpdateAugust 16, 20183 updates tracked since enumeration

✔ NPI 1699769786 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyInternal Medicine · Cardiovascular DiseaseAllopathic & Osteopathic Physicians

Taxonomy Code207RC0000X

License✔ Licensed in OR · MD22839

Definition

An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms.

Also ListedSpecialistTaxonomy 174400000X · License MD22839 (OR)

2222 NW LOVEJOY ST, Portland, OR 97210

Open in Google Maps ↗

Secondary Practice Locations 4

Location 124900 SE Stark St Ste 103Gresham, OR 97030-3381 · Phone (503) 907-1101 · Fax (503) 907-0177

Location 219260 SW 65th Ave Ste 420Tualatin, OR 97062-5712 · Phone (503) 692-0405 · Fax (503) 692-7978

Location 3500 N Columbia River HwySaint Helens, OR 97051-1299 · Phone (503) 229-7554 · Fax (503) 248-4666

Location 42121 NE 139th St Ste 360Vancouver, WA 98686-2316 · Phone (360) 213-0085 · Fax (360) 213-0049

Other Identifiers 2

Medicaid287717OR

Medicaid1016616WA

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BridgeSpan Health Company, Moda Health Plan, Inc., PacificSource Health Plans and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Shawn Timothy Patrick M.d. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID1254466733

PECOS Enrollment IDI20100323000531, I20130522000593

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

Medicare enrollment records show Shawn Patrick reassigns Medicare billing to 6 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Legacy Good Samaritan Hospital And Medical Center

0.1 mi

General Acute Care Hospital

1015 NW 22ND AVE
Portland, OR 97210

Reassigned Medicare billing, Oregon enrollment
387 clinicians in this Medicare group

NPI 1780608216 (503) 413-7711

Legacy Clinics LLC

0.1 mi

Clinic/Center

1130 NW 22ND AVE STE 220
Portland, OR 97210

Reassigned Medicare billing, Oregon enrollment
1,248 clinicians in this Medicare group

NPI 1902827272 (503) 413-2901

Legacy Emanuel Hospital & Health Center

1.6 mi

General Acute Care Hospital

1225 NE 2ND AVE
Portland, OR 97232

Reassigned Medicare billing, Oregon enrollment
719 clinicians in this Medicare group

NPI 1003367491 (503) 944-8000

Legacy Meridian Park Hospital

11 mi

Hospitalist

19300 SW 65TH AVE
Tualatin, OR 97062

Reassigned Medicare billing, Oregon enrollment
218 clinicians in this Medicare group

NPI 1023305034 (503) 692-1212

Legacy Salmon Creek Hospital

13 mi

Clinic/Center

2211 NE 139TH ST
Vancouver, WA 98686

Reassigned Medicare billing, Washington enrollment
754 clinicians in this Medicare group

NPI 1356357784 (360) 487-2878

Legacy Mount Hood Medical Center

14 mi

General Acute Care Hospital

24800 SE STARK ST
Gresham, OR 97030

Reassigned Medicare billing, Oregon enrollment
132 clinicians in this Medicare group

NPI 1255354700 (503) 674-1122

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

Areas of Expertise CMS Part B claims 27

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

359 services303 patients

Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only 93010

A routine electrocardiogram (ECG) with 12 leads is a simple, non-invasive test that records the electrical activity of your heart. It helps in identifying heart conditions by detecting irregularities in your heart rhythms. The results are interpreted and a report is provided.

348 services271 patients

Ultrasound of heart with color-depicted blood flow, rate, direction and valve function 93306

This is a heart ultrasound, also known as an echocardiogram. It uses sound waves to create pictures of your heart, showing how blood flows through it. The color depicts the blood flow's speed and direction. It also checks the heart's valves to ensure they're working properly.

226 services222 patients

Evaluation of single, dual, multiple lead or leadless pacemaker system, remote up to 90 days 93294

This procedure evaluates your pacemaker system remotely for up to 90 days. It checks whether single, dual, multiple lead, or leadless pacemakers are working properly. It's a safe, convenient way to ensure your heart device is functioning optimally.

201 services89 patients

Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes 99233

Follow-up hospital inpatient care per day typically involves a 35-minute check-up by your healthcare provider. This service includes monitoring your health progress, adjusting your treatment plan if needed, and answering any questions you may have about your condition or care.

126 services64 patients

Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report 93000

An electrocardiogram (ECG) is a non-invasive test that records your heart's electrical activity. Using 12 leads attached to your body, it captures data to help identify heart conditions. A doctor interprets the results and provides a report.

111 services106 patients

New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more 99205

This is a first-time patient visit where a healthcare professional spends 60-74 minutes with you. It involves a comprehensive evaluation, including your medical history and current health condition. They'll also advise on preventive health measures and formulate a treatment plan if needed.

87 services87 patients

Ultrasound of heart with color-depicted blood flow, rate, direction and valve function 93306

74 services73 patients

Injection, perflutren lipid microspheres, per ml Q9957

Perflutren lipid microspheres injection, per ml, is a diagnostic tool used to enhance ultrasound images. It contains tiny gas-filled bubbles that improve the clarity of the images, aiding in a more accurate diagnosis.

65 services35 patients

Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes 99223

Initial hospital inpatient care per day, typically 70 minutes, refers to the daily medical service provided to patients admitted to the hospital. This includes a comprehensive evaluation, diagnosis, treatment plan, and monitoring of your health condition. It ensures your well-being during your hospital stay.

50 services49 patients

Programming of dual lead pacemaker system 93280

Programming of a dual lead pacemaker system is a procedure to adjust your heart's pacemaker settings. This process involves a small device, called a programmer, that communicates with your pacemaker to ensure it's working optimally for your heart's needs.

48 services39 patients

Ultrasound of heart, follow-up 93308

A follow-up ultrasound of the heart, also known as an echocardiogram, is a non-invasive test that uses sound waves to create images of your heart. It helps doctors monitor your heart's function and structures after initial assessment or treatment.

46 services43 patients

Ultrasound of heart blood flow, valves and chambers, follow-up 93321

This procedure, an echocardiogram, uses sound waves to create images of your heart. It aids in assessing your heart's blood flow, chambers, and valves. It's a follow-up procedure, ensuring that your heart is functioning properly post-treatment.

46 services43 patients

Insertion of tube in coronary artery for diagnosis with review by radiologist 93454

This procedure involves placing a small tube into your coronary artery. It helps to identify any blockages or issues within the artery. A radiologist, a doctor specialized in medical imaging, will review the results to ensure accurate diagnosis.

29 services29 patients

Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more 99215

This service involves a follow-up appointment for existing patients, lasting between 40 to 54 minutes. During this time, your healthcare provider will assess your current health status, discuss any changes or concerns, review your treatment plan, and answer any questions you may have.

29 services27 patients

Ultrasound of heart blood flow, valves and chambers 93320

An ultrasound of your heart, also known as an echocardiogram, is a test that uses sound waves to create detailed images of your heart. It helps doctors check the health of your heart's chambers, valves, and blood flow.

22 services22 patients

Ultrasound of heart with color-depicted blood flow, rate and valve function 93325

An ultrasound of the heart, also known as an echocardiogram, uses sound waves to create pictures of your heart. It shows the structure, movement, and blood flow within your heart. This helps assess the heart's health and function, including the valves and rate.

22 services22 patients

Ultrasound of heart with continuous electrocardiogram (ecg) during rest, exercise and/or drug induced stress with review and report 93351

This procedure involves using ultrasound technology to create images of your heart while you rest, exercise, or undergo drug-induced stress. An ECG continuously monitors your heart's electrical activity. It helps doctors assess heart health and function.

22 services22 patients

Heart rhythm review, and interpretation of continous external ekg over more than 48 hours up to 7 days 93244

A heart rhythm review involves monitoring your heart's electrical activity for more than 48 hours up to 7 days. Using a device called an external EKG, doctors can track your heartbeats to detect irregularities and help diagnose heart conditions.

15 services15 patients

Heart rhythm review, and interpretation of continous external ekg over more than 48 hours up to 7 days 93244

15 services15 patients

Ultrasound of heart with probe in esophagus, with report 93312

This procedure, called a transesophageal echocardiogram, uses a small probe passed into your esophagus to capture detailed images of your heart. The report provides information about your heart's structure and function.

15 services15 patients

Heart rhythm recording continous external ekg over more than 48 hours up to 7 days 93242

This procedure involves wearing a device, an external EKG, for up to 7 days to continuously monitor your heart rhythm. It helps detect irregularities that may not occur during a standard EKG. The device is non-invasive and safe.

14 services14 patients

Electrocardiogram (ecg) up to 30 days continuous with review and report by health care professional 93228

An Electrocardiogram (ECG) is a non-invasive test that records the electrical signals in your heart. For up to 30 days, a small device will continuously monitor your heart's activity. A healthcare professional will then review the data and provide a report on your heart's function.

13 services12 patients

Heart rhythm review and interpretation of continous external ekg over 8-15 days 93248

This service involves wearing a device for 8-15 days that continuously records your heart's electrical activity. It helps in identifying irregular heart rhythms. The recorded data is then reviewed and interpreted by a healthcare professional for any abnormalities.

13 services13 patients

Telephone medical discussion with physician, 21-30 minutes 99443

This service involves a 21-30 minute phone conversation with a physician. It's a chance for you to discuss your health concerns, symptoms or treatment plans. It's similar to an in-person consultation, but conducted over the phone for your convenience and safety.

12 services12 patients

Insertion of pacemaker and upper and lower heart chamber electrode 33208

A pacemaker insertion is a procedure where a small device, called a pacemaker, is implanted under your skin. This device uses electrical pulses to prompt the heart to beat at a normal rate. Electrodes are placed in the upper and lower chambers of your heart to help regulate your heartbeat.

11 services11 patients

External shock to heart to regulate heart beat 92960

This procedure, known as cardioversion, uses an external electrical shock to restore your heart's normal rhythm. It's typically performed when irregular heartbeats, or arrhythmias, are causing severe symptoms and aren't responding to medications.

11 services11 patients

Hospital Affiliations CMS Care Compare 5

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Legacy Emanuel Medical Center

Acute Care Hospitals · Portland, OR

3/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number380007

Location2801 N Gantenbein AvenuePortland, OR 97227 · Multnomah County

Emergency services Birthing friendly

Legacy Good Samaritan Medical Center

Acute Care Hospitals · Portland, OR

5/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number380017

Location1015 NW 22nd Avenue, W121Portland, OR 97210 · Multnomah County

Emergency services Birthing friendly

Legacy Mount Hood Medical Center

Acute Care Hospitals · Gresham, OR

4/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number380025

Location24800 SE Stark StreetGresham, OR 97030 · Multnomah County

Emergency services Birthing friendly

Legacy Meridian Park Medical Center

Acute Care Hospitals · Tualatin, OR

2/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number380089

Location19300 SW 65th AvenueTualatin, OR 97062 · Washington County

Emergency services Birthing friendly

Columbia Memorial Hospital

Critical Access Hospitals · Astoria, OR

OwnershipProprietary

CMS Certification Number381320

Location2111 Exchange StreetAstoria, OR 97103 · Clatsop County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 97210 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$134.16 typical visit price

range $58.99 – $176.88

Typical copayment $33.54 (range $14.74 – $44.22)

Most-billed visit code 99204

Established Patient

$73.28 typical visit price

range $19.32 – $144.79

Typical copayment $18.32 (range $4.83 – $36.19)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

85.78/100

MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program

Scored as part of a group practice

Quality

96.89

Promoting Interoperability

100

Improvement Activities

Cost

48.45

Reported Quality Measures

Cervical Cancer Screening

Percentage of women 21-64 years of age who were screened for cervical cancer using either of the following criteria: - Women age 21-64 who had cervical cytology performed every 3 years - Women age 30-64 who had cervical cytology/human papillomavirus (HPV)…

9%86 patients

Colorectal Cancer Screening

Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer

21%374 patients2/55-star benchmark: 85%

Diabetes: Medical Attention for Nephropathy

The percentage of patients 18-75 years of age with diabetes who had a nephropathy screening test or evidence of nephropathy during the measurement period

83%70 patients4/55-star benchmark: 99%

Documentation of Current Medications in the Medical Record

Percentage of visits for patients aged 18 years and older for which the eligible professional or eligible clinician attests to documenting a list of current medications using all immediate resources available on the date of the encounter.

94%1,017 patients4/55-star benchmark: 100%

e-Prescribing

At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology.

96%1,362 patients4/55-star benchmark: 100%

Falls: Screening for Future Fall Risk

Percentage of patients 65 years of age and older who were screened for future fall risk during the measurement period

16%484 patients1/55-star benchmark: 99%

Medication Reconciliation

The MIPS eligible clinician performs medication reconciliation for at least one transition of care in which the patient is transitioned into the care of the MIPS eligible clinician.

93%538 patients4/55-star benchmark: 100%

Patient-Specific Education

The MIPS eligible clinician must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide access to those materials to at least one unique patient seen by the MIPS eligible clinician.

94%720 patients4/55-star benchmark: 99%

Pneumococcal Vaccination Status for Older Adults

Percentage of patients 65 years of age and older who have ever received a pneumococcal vaccine

24%485 patients2/55-star benchmark: 90%

Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan

Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the previous twelve months AND with a BMI outside of normal parameters, a follow-up plan is documented during the encounter or during the previous…

96%715 patients4/55-star benchmark: 97%

Preventive Care and Screening: Influenza Immunization

Percentage of patients aged 6 months and older seen for a visit between October 1 and March 31 who received an influenza immunization OR who reported previous receipt of an influenza immunization

16%457 patients1/55-star benchmark: 88%

Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention

Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received tobacco cessation intervention if identified as a tobacco user

Patients tobacco: 95% · 226 patients

95%226 patients

Provide Patient Access

At least one patient seen by the MIPS eligible clinician during the performance period is provided timely access to view online, download, and transmit to a third party their health information subject to the MIPS eligible clinician's discretion to withhold…

74%720 patients3/55-star benchmark: 100%

Secure Messaging

For at least one unique patient seen by the MIPS eligible clinician during the performance period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient-authorized representative), or in response to a secure…

16%720 patients2/55-star benchmark: 59%

Use of High-Risk Medications in the Elderly

Percentage of patients 65 years of age and older who were ordered high-risk medications. Two rates are submitted. 1) Percentage of patients who were ordered at least one high-risk medication.

Lower rates are better for this measure.

Patients 2+: 0% · 485 patients

0%485 patients5/55-star benchmark: 100%

View, Download, or Transmit (VDT)

At least one patient seen by the MIPS eligible clinician during the performance period (or patient-authorized representative) views, downloads or transmits their health information to a third party during the performance period.

11%720 patients

Providers report different measures because they deliver different services; reporting more or less information is not a reflection of quality. Star ratings appear only where CMS assigned them.

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.

PRISCILLA D LE MD

Internal Medicine

2222 NW LOVEJOY ST, STE 505
PORTLAND, OR 97210

Multnomah County (503) 226-4091

ERIC LOUIS PACINI MD

Internal Medicine (Cardiovascular Disease)

2222 NW LOVEJOY ST, STE. 606
PORTLAND, OR 97210

Multnomah County (503) 229-7554

ANGELA MASSONI-BLAINE

Nurse Practitioner (Adult Health)

2222 NW LOVEJOY ST
PORTLAND, OR 97210

Multnomah County (503) 413-8036

DR. DAVID E WU M.D.

Internal Medicine (Interventional Cardiology)

2222 NW LOVEJOY ST, SUITE 606
PORTLAND, OR 97210

Multnomah County (503) 229-7554

DR. DUANE ALLEN LUNDEBERG MD

Otolaryngology

2222 NW LOVEJOY ST, SUITE #622
PORTLAND, OR 97210

Multnomah County (503) 229-8455

DR. LARRY RICHARD THOMAS MD

Otolaryngology

2222 NW LOVEJOY ST, SUITE #622
PORTLAND, OR 97210

Multnomah County (503) 229-8455

HEART CENTERS OF AMERICA LLC

Internal Medicine (Cardiovascular Disease)

2222 NW LOVEJOY ST, SUITE 512
PORTLAND, OR 97210

Multnomah County (503) 222-0262

ALBERT HENRY KRAUSE MD

Thoracic Surgery (Cardiothoracic Vascular Surgery)

2222 NW LOVEJOY ST, SUITE 315
PORTLAND, OR 97210

Multnomah County (503) 226-6321

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 Shawn Patrick's NPI number?

The NPI number for Shawn Patrick is 1699769786. It was assigned to this individual provider in the NPPES registry on September 6, 2005.

Where is Shawn Patrick located?

Shawn Patrick practices at 2222 NW Lovejoy St Suite 606, Portland, OR 97210. The listed phone number is (503) 229-7554.

What is Shawn Patrick's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Cardiovascular Disease, with taxonomy code 207RC0000X.

Is Shawn Patrick enrolled in Medicare?

Yes. Shawn Patrick is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organizations bill Medicare for Shawn Patrick's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Shawn Patrick reassigns Medicare benefits to 6 organizations: Legacy Good Samaritan Hospital And Medical Center (Portland, OR), Legacy Clinics LLC (Portland, OR), Legacy Emanuel Hospital & Health Center (Portland, OR), Legacy Meridian Park Hospital (Tualatin, OR), Legacy Salmon Creek Hospital (Vancouver, WA) and 1 more organization, listed in the Medicare section above. Each 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 Shawn Patrick's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Shawn Patrick accept?

Health plans from BridgeSpan Health Company, Moda Health Plan, Inc., PacificSource Health Plans and Regence BlueCross BlueShield of Oregon list Shawn Patrick 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.

Is Shawn Patrick affiliated with any hospitals?

According to CMS data, Shawn Patrick is affiliated with Legacy Emanuel Medical Center, Legacy Good Samaritan Medical Center, Legacy Mount Hood Medical Center, Legacy Meridian Park Medical Center and Columbia Memorial Hospital.

When was this NPI record last updated?

The NPPES record for Shawn Patrick was last updated on August 16, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 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.