PROVIDENCE HEALTH & SERVICES - OREGON – NPI #1578854857
Internal Medicine

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.

Health Care Provider Taxonomy Code for Internal Medicine

PROVIDENCE HEALTH & SERVICES - OREGON is a provider located in PORTLAND, OR. NPPES has assigned the NPI number 1578854857 to PROVIDENCE HEALTH & SERVICES - OREGON on April 21, 2011. It is a Type-2 NPI, indicating this NPI number is associated with an organization. The NPI data also shows multiple names associated with this provider such as Providence Heart Clinic at The Oregon Clinic Gateway and 2 other listed below. With multiple taxonomy codes selected, the primary taxonomy selected by this provider is 207RC0000X from the Health Care Provider Taxonomy code set, which is classified as Internal Medicine, specializing in Cardiovascular Disease

The NPI profile was last updated on Mar 23, 2026. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for PROVIDENCE HEALTH & SERVICES - OREGON below.

NPI Profile for
PROVIDENCE HEALTH & SERVICES - OREGON

NPI Number
1578854857
Enumeration Date

(more than 15 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
PROVIDENCE HEALTH & SERVICES - OREGON
Other name(s)
All associated names:
Doing Business As (dba)
Providence Heart Clinic at The Oregon Clinic Gateway
Doing Business As (dba)
Providence Heart Clinic Hollywood
Doing Business As (dba)
PROVIDENCE MEDICAL GROUP
Primary location
4400 NE HALSEY ST STE 102
PORTLAND, OR 97213-1545
Phone: (503) 962-1000 Fax:
1 Other location(s):
1111 NE 99th Ave
Suite 201
Portland, OR 97220-9442
Phone: (503) 962-1000
Mailing address
PO BOX 31001 - 4180
PASADENA, CA 91110-4180
Phone: Fax:
Organization Subpart
No
Authorized Official
DONALD ANDERSON
ASSISTANT SECRETARY OF ENROLLMENTS
Phone: (425) 358-9786
Updated
Certification Date
Mar 23, 2026

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Identifiers

Identifiers for PROVIDENCE HEALTH & SERVICES - OREGON

Identifiers are used to associate other provider identifiers such as Medicaid or other insurers (ie:, Blue Cross, Blue Shield, Aetna, Kaiser-Permanente, etc.), with their NPI number. These identifiers can be used in matching an NPI number to an insurer's records. However, not all providers have such numbers and not all providers choose to include them in their NPI information.

DescriptionIssuerStateIdentifier
medicaidOR500639203
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
207RC0000X
- Internal Medicine / Cardiovascular Disease (Primary)
261QM1300X
- Clinic/Center / Multi-Specialty
261Q00000X
- Clinic/Center

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.