Unknown Individual – Pediatric Radiology Physician, NPI 1639384035

Pediatric Radiology Physician

Unknown Individual is a healthcare provider. based in Portland, Oregon. specializing in Pediatric Radiology Physician. They hold a License No. MD28423 (OR). The NPI Number for Unknown Individual is 1639384035

Main info

Organization

Inactive

25 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1639384035

Phone

(503) 418-0990

Address

3181 SW SAM JACKSON PARK RD

Deactivation Date

16 March 2022

Doctor Profile

Medical School Name

ALBERT EINSTEIN COLLEGE OF MEDICINE OF YESHIVA UNIVERSITY

Secondary Phone

5034134032

Graduation Year

2001 (25 years ago)

PAC ID

7911087325

Group Practice PAC ID

0840221230

Professional Enrollment ID

I20090422000351

Data current as of

19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience19

Completeness75

Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

Richard T. Jones Hall, 3181, Southwest Sam Jackson Park Road, Marquam Hill, Homestead, Portland, Metro, Multnomah County, Oregon, 97239, United States
PORTLAND, OR 972393011
Phone: (503) 418-0990
Fax: (503) 494-4982
Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 97239)

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Provider's Procedures

Unknown Individual performs procedures in Pediatric Radiology Physician. See the list of HCPCS codes below.

Specialty	Practice State	HCPCS Code	Description	Service Count	Beneficiary Count
DIAGNOSTIC RADIOLOGY	PA	71010	X-ray of chest, 1 view, front	158	114
DIAGNOSTIC RADIOLOGY	PA	73630	X-ray of foot, minimum of 3 views	14	13
DIAGNOSTIC RADIOLOGY	PA	74177	CT scan of abdomen and pelvis with contrast	23	23

Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.

PAC ID: 0840221230View full group profile

Name	Specialty	State
JOEL ROBERSON (M.D.)	Diagnostic Radiology	MN
JOHN GUSTAVSSON (MD)	Diagnostic Radiology	OR
DR. JAMES R GILMORE (M.D.)	Diagnostic Radiology	OR
RICHARD B HESLA (MD)	-	OR
DAVID P CIAVERELLA (DO)	Diagnostic Radiology	OR
DR. PHILLIP ADAM SETRAN (MD)	Diagnostic Radiology	WA
RAFAEL SILVA (MD)	Diagnostic Radiology	OR

Reviews

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Frequently asked questions

How is Unknown Individual identified in CMS data?

CMS-hosted NPPES data lists Unknown Individual with NPI 1639384035.

Why is Unknown Individual marked inactive in the NPI directory?

The public NPI listing for Unknown Individual is not currently active; confirm directly with the practice or licensing boards.

What is Unknown Individual's primary classification?

Pediatric Radiology Physician is the headline specialty for Unknown Individual here. Clinical services aligned with this taxonomy classification.

Does Unknown Individual list a practice location?

Patients near Portland, Oregon may find Unknown Individual in results; validate coverage separately.

Why does Unknown Individual have multiple addresses?

2 practice locations appear in the available data. Multiple addresses are common for hospital privileges, telehealth, or multi-site groups.

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