Childrens Cardiac Center of Oregon – Pediatric Cardiology Physician, NPI 1144287541
Pediatric Cardiology Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Childrens Cardiac Center of Oregon
Surrey Parks 110A Sullivan Street Sports Box, Sullivan Street, Crescent Beach, South Surrey, Surrey, Metro Vancouver Regional District, British Columbia, V4A 3V2, Canada
VANCOUVER, WA 986820030
Phone: (503) 280-3418
Fax: (503) 284-7885
Type: Mailing
Legacy Medical Group- Northeast, 300, North Graham Street, Albina, Eliot, Portland, Metro, Multnomah County, Oregon, 97227, United States
SUITE 250
PORTLAND, OR 972271683
Phone: (503) 280-3418
Fax: (503) 284-7885
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: 2004-08-04
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20040804000484 | O | Clinic/Group Practice | OR | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
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 98682)
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