PROVIDENCE MEDICAL GROUP SOUTH – Family Medicine Physician, NPI 1568547503
Family Medicine Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for PROVIDENCE MEDICAL GROUP SOUTH
3158, Southwest 87th Avenue, Portland, Metro, Washington County, Oregon, 97225, United States
PORTLAND, OR 972083158
Phone: (503) 215-6494
Type: Mailing
PO BOX 31001 - 4180
PASADENA, CA 911104180
Phone: (503) 215-6494
Type: Mailing
965, Ellendale Drive, Medford, Jackson County, Oregon, 97504, United States
MEDFORD, OR 975048215
Phone: (541) 732-6000
Fax: (541) 732-6005
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
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Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2004-03-10
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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