PROVIDENCE MEDICAL GROUP WILSONVILLE – Family Medicine Physician, NPI 1245489087

PROVIDENCE MEDICAL GROUP WILSONVILLE is a healthcare provider. based in Portland, Oregon. specializing in Family Medicine Physician. The NPI Number for PROVIDENCE MEDICAL GROUP WILSONVILLE is 1245489087

Main info

Organization
Name
PROVIDENCE MEDICAL GROUP WILSONVILLE
NPI
1245489087
Phone
Not provided
Address
PO BOX 3158
Authorized Official
DONALD WAYNE ANDERSON JR. ASST SEC FOR ENROLLMENT
Enumeration Date
17 September 2008
Last Update Date
20 June 2025
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience54
Completeness90
Years active:17State licenses:0Digital endpoints

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Provider Addresses for PROVIDENCE MEDICAL GROUP WILSONVILLE

  • 3158, Southwest 87th Avenue, Portland, Metro, Washington County, Oregon, 97225, United States

    PORTLAND, OR 972083158

    Phone:

    Type: Mailing

  • PO BOX 31001 - 4180

    PASADENA, CA 911104180

    Phone:

    Type: Mailing

  • 29345, Southwest Town Center Loop East, Wilsonville, Metro, Clackamas County, Oregon, 97070, United States

    SUITE 110

    WILSONVILLE, OR 970708486

    Phone: (503) 582-2100

    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.

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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.

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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

Where can patients find PROVIDENCE MEDICAL GROUP WILSONVILLE's NPI?
You can confirm PROVIDENCE MEDICAL GROUP WILSONVILLE with NPI 1245489087; it appears in the national provider directory.
Does this profile mean PROVIDENCE MEDICAL GROUP WILSONVILLE is currently active?
Yes — PROVIDENCE MEDICAL GROUP WILSONVILLE appears active in the national provider directory.
Does PROVIDENCE MEDICAL GROUP WILSONVILLE list a primary specialty?
If you are matching referrals, note Family Medicine Physician for PROVIDENCE MEDICAL GROUP WILSONVILLE. Clinical services aligned with this taxonomy classification.
Where does public data place PROVIDENCE MEDICAL GROUP WILSONVILLE?
The snapshot lists Portland, Oregon for PROVIDENCE MEDICAL GROUP WILSONVILLE; download NPPES for the complete set.
Does Medicare enrollment show here?
Medicare enrollment screens are separate from the basic NPI extract shown here.

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