PROVIDENCE MEDICAL GROUP – General Practice Physician, NPI 1023488343
General Practice Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
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)
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Medicare Enrollment & Revalidation
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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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