PROVIDENCE HEALTH & SERVICES - OREGON
NPI 1790107050
Dermatology in Clackamas, OR

Q: What is Providence Health & Services - Oregon's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

Active since January 06, 2014

9290 SE SUNNYBROOK BLVD, SUITE 120, CLACKAMAS, OR 97015(503) 215-9080(503) 215-9099 Get Directions Write a Review

NPPES record last updated: July 1, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jul 1, 2025, May 5, 2025 (2 updates tracked since 2025).

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About Providence Health & Services - Oregon NPPES

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

PROVIDENCE HEALTH & SERVICES - OREGON (NPI 1790107050), doing business as Providence Medical Group, is a healthcare organization registered as a dermatology in Clackamas, Oregon and active in the NPI registry since January 2014. The organization lists Donald Wayne Anderson, Asst Sec Enrollment, as its authorized official.

NPPES Registry Identity

NPI1790107050

Entity TypeOrganization

Primary Taxonomy207N00000X

Legal Business NamePROVIDENCE HEALTH & SERVICES - OREGON

Location Address9290 SE SUNNYBROOK BLVD, SUITE 120Clackamas, OR 97015-6802

Mailing AddressPo Box 31001 - 4180Pasadena, CA 91110-4180

Phone(503) 215-9080

Fax(503) 215-9099

Organization SubpartNo

Authorized OfficialDonald Wayne AndersonAsst Sec Enrollment · (425) 358-9786

Enumeration DateJanuary 6, 2014

Last NPPES UpdateJuly 1, 20252 updates tracked since enumeration

NPPES CertifiedJuly 1, 2025

✔ NPI 1790107050 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians

Taxonomy Code207N00000X

Definition

A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.

Also ListedClinic/CenterTaxonomy 261Q00000X

9290 SE SUNNYBROOK BLVD, Clackamas, OR 97015

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Other Names 2

Doing Business AsProvidence Medical Group

Doing Business AsProvidence Medical Group Glisan Dermatology At Sunnyside

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Providence Health & Services - Oregon is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

1,498

Medicare enrollment records show 1,498 clinicians reassign Medicare billing to Providence Health & Services - Oregon, which bills Medicare for the services they deliver. Of these, 12 practice at this address and 684 within 10 miles. Listed here are the 20 practicing nearest to this location.

Clinicians by Medicare Specialty 56

Internal Medicine250

Family Practice212

Nurse Practitioner210

Hospitalist96

Neurology57

Obstetrics/Gynecology57

Physical Therapist in Private Practice54

Clinical Psychologist53

48 other specialties509

Nearest to this location (20)

See all 1,498

Melissa Arce, RD

Registered Dietitian or Nutrition Professional

NPI 1376206151

9290 SE SUNNYBROOK BLVD STE 120
Clackamas, OR 97015

(503) 215-2110

✔ Accepts MedicareSame address

Edmund Beck, MD

Family Practice

NPI 1508894718

9290 SE SUNNYBROOK BLVD SUITE 120
Clackamas, OR 97015

(503) 215-2110

✔ PECOS✔ Accepts MedicareSame address

Rachel Boneski, DO

Family Practice

NPI 1598261372

9290 SE SUNNYBROOK BLVD STE 120
Clackamas, OR 97015

(503) 215-2110

✔ PECOS✔ Accepts MedicareSame address

Gregory Garcia, MD

Internal Medicine

NPI 1922036219

9290 SE SUNNYBROOK BLVD SUITE 120
Clackamas, OR 97015

(503) 215-2110

✔ PECOS✔ Accepts MedicareSame address

Ewen Harrison, MD

Family Practice

NPI 1841647559

9290 SE SUNNYBROOK BLVD STE 120
Clackamas, OR 97015

(503) 215-2110

✔ PECOS✔ Accepts MedicareSame address

Brent Hoffman, D.O.

Family Practice

NPI 1841239076

9290 SE SUNNYBROOK BLVD SUITE 120
Clackamas, OR 97015

(503) 215-2110

✔ PECOS✔ Accepts MedicareSame address

Lauren Moore, DO

Family Practice

NPI 1528509445

9290 SE SUNNYBROOK BLVD STE 120
Clackamas, OR 97015

(503) 215-2110

✔ PECOS✔ Accepts MedicareSame address

Navin Nayak, MD

Internal Medicine

NPI 1063467181

9290 SE SUNNYBROOK BLVD SUITE 120
Clackamas, OR 97015

(503) 215-2110

✔ PECOS✔ Accepts MedicareSame address

Catherine Wagoner, MD

Pediatric Medicine

NPI 1487627550

9290 SE SUNNYBROOK BLVD STE 120
Clackamas, OR 97015

(503) 215-2110

✔ PECOSSame address

Rachel Gallagher, MD

Family Practice

NPI 1386349579

9290 SE SUNNYBROOK BLVD STE 120
Clackamas, OR 97015

(503) 215-2110

✔ PECOSSame address

Janet Ruzich, DO

Medical Oncology

NPI 1508869140

9280 SE SUNNYBROOK BLVD STE 200
Clackamas, OR 97015

(503) 513-1900

✔ PECOS✔ Accepts MedicareSame address

Alice Nayak, MD

Internal Medicine

NPI 1013962513

9290 SE SUNNYBROOK BLVD SUITE 120
Clackamas, OR 97015

(503) 215-2110

✔ PECOS✔ Accepts MedicareSame address

Jennifer Stager, MA CCC-SLP

Qualified Speech Language Pathologist

NPI 1154449858

10180 SE SUNNYSIDE RD
Clackamas, OR 97015

(800) 813-2000

✔ Accepts Medicare0.4 mi

John Steeh, D.O.

Emergency Medicine

NPI 1447359914

10180 S.E. SUNNYSIDE ROAD
Clackamas, OR 97015

(503) 652-2880

✔ PECOS✔ Accepts Medicare0.4 mi

Hayley Hirt, CNM

Certified Nurse Midwife (CNM)

NPI 1154935252

10100 SE SUNNYSIDE RD
Clackamas, OR 97015

(503) 813-2000

✔ PECOS0.5 mi

Zachary Pena, M.D.

Dermatology

NPI 1538592399

10151 SE SUNNYSIDE RD STE 240
Clackamas, OR 97015

(503) 962-1840

✔ PECOS✔ Accepts Medicare0.6 mi

Mary Clare Bohnett, MD

Dermatology

NPI 1710482013

10151 SE SUNNYSIDE RD STE 240
Clackamas, OR 97015

(503) 962-1840

✔ PECOS✔ Accepts Medicare0.6 mi

Andrew Touati, MD

Dermatology

NPI 1730671645

10151 SE SUNNYSIDE RD STE 240
Clackamas, OR 97015

(503) 962-1840

✔ PECOS✔ Accepts Medicare0.6 mi

Laura Milner, PSY. D

Clinical Psychologist

NPI 1144560582

11211 SE 82ND AVE SUITE O
Happy Valley, OR 97086

(503) 722-6200

✔ PECOS✔ Accepts Medicare1.1 mi

Edward Lin, D.O.

Family Practice

NPI 1659783546

5111 SE LAKE RD
Milwaukie, OR 97222

(503) 771-0055

✔ PECOS✔ Accepts Medicare2.0 mi

See all 1,498 clinicians

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

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 Providence Health & Services - Oregon's NPI number?

The NPI number for Providence Health & Services - Oregon is 1790107050. It was assigned to this organization in the NPPES registry on January 6, 2014. The provider is doing business as Providence Medical Group and Providence Medical Group Glisan Dermatology at Sunnyside.

Where is Providence Health & Services - Oregon located?

Providence Health & Services - Oregon is located at 9290 SE Sunnybrook Blvd Suite 120, Clackamas, OR 97015. The listed phone number is (503) 215-9080.

What is Providence Health & Services - Oregon's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

Is Providence Health & Services - Oregon enrolled in Medicare?

Yes. Providence Health & Services - Oregon is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Providence Health & Services - Oregon?

According to the CMS Revalidation Reassignment List (October 2026 release), 1,498 clinicians in 56 Medicare specialties reassign their Medicare billing to Providence Health & Services - Oregon. 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 (250), Family Practice (212) and Nurse Practitioner (210). Of these, 12 practice at this address and 684 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Providence Health & Services - Oregon was last updated on July 1, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 months 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.