PROVIDENCE MEDICAL GROUP – General Practice Physician, NPI 1023488343

PROVIDENCE MEDICAL GROUP is a healthcare provider. based in Portland, Oregon. specializing in General Practice Physician. The NPI Number for PROVIDENCE MEDICAL GROUP is 1023488343

Main info

Organization
Name
PROVIDENCE MEDICAL GROUP
NPI
1023488343
Phone
Not provided
Address
PO BOX 3158
Authorized Official
DONALD WAYNE ANDERSON JR. ASST SECRETARY FOR ENROLLMENT
Enumeration Date
29 September 2015
Last Update Date
20 June 2025
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience40
Completeness90
Years active:10State licenses:0Digital endpoints

Provider Addresses for PROVIDENCE MEDICAL GROUP

  • PO BOX 3158

    PORTLAND, OR 972083158

    Phone:

    Type: Mailing

  • PO BOX 31001 - 4180

    PASADENA, CA 911104180

    Phone:

    Type: Mailing

  • 4823 MEADOWS RD

    LAKE OSWEGO, OR 970352529

    Phone: (503) 216-1580

    Type: Location

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.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2003-11-06

PECOS data refreshed: 2026-05-27

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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 97208)

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Reviews

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Frequently asked questions

Is PROVIDENCE MEDICAL GROUP listed with a National Provider Identifier?
Yes — PROVIDENCE MEDICAL GROUP has NPI 1023488343 on file in the registry.
Is there an active status for PROVIDENCE MEDICAL GROUP?
For scheduling context, PROVIDENCE MEDICAL GROUP is shown as active in the registry.
How would a patient describe PROVIDENCE MEDICAL GROUP's focus?
For PROVIDENCE MEDICAL GROUP, the primary taxonomy reads as General Practice Physician. Clinical services aligned with this taxonomy classification.
Is PROVIDENCE MEDICAL GROUP located near Portland?
PROVIDENCE MEDICAL GROUP currently maps to Portland, Oregon in this extract.
Can I trust this NPI listing for PROVIDENCE MEDICAL GROUP?
The listing is sourced from the national NPI registry. If something looks off, compare with NPPES and the clinic's website.

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