FAMILY MEDICAL GROUP NORTHEAST, P.C. - NPI 1831385673

Q: What is the provider's specialty?

The provider's specialty is Family Medicine with taxonomy code 207Q00000X.

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About Family Medical Group Northeast, P.c. NPPES

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

FAMILY MEDICAL GROUP NORTHEAST, P.C. (NPI 1831385673) is a healthcare organization registered as a family medicine in Portland, Oregon and active in the NPI registry since September 2007. The organization holds a CLIA Waiver certificate valid through February 13, 2027 and lists Keirene Adams, Administrator, as its authorized official.

NPPES Registry Identity

NPI1831385673

Entity TypeOrganization

Primary Taxonomy207Q00000X

Legal Business NameFAMILY MEDICAL GROUP NORTHEAST, P.C.

Location Address2647 NE 33RD AVEPortland, OR 97212-3647

Mailing Address2647 Ne 33rd AvePortland, OR 97212-3647 · (503) 288-0083 · Fax (503) 288-7843

Phone(503) 288-0083

Fax(503) 288-7843

Organization SubpartNo

Authorized OfficialKeirene AdamsAdministrator · (503) 288-0083

Enumeration DateSeptember 14, 2007

✔ NPI 1831385673 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

2647 NE 33RD AVE, Portland, OR 97212

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Other Identifiers 1

OtherR000WCHMDOR · Medicare Group Number

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 Providence Health Plan.Insurance ›

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 Waiver 38D0623880

Family Medical Group, NE · Portland, OR

Active · expires Feb 13, 2027

CLIA Number38D0623880

Laboratory TypePhysician Office

Certificate Effective DateFebruary 14, 2025

Certificate Expiration DateFebruary 13, 2027

Laboratory DirectorDeona L. Bridgeman

Laboratory Phone(503) 288-0083

Laboratory LocationFamily Medical Group, NE2647 NE 33rd Ave, Portland, OR 97212

CLIA data matches this NPI record on: Address Phone

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 7

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

THOMAS P HARVEY MD

Family Medicine