NORTHWEST GASTROENTEROLOGY CLINIC LLC (NPI# 1407933872) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407933872 |
| Entity Type | Organization |
| Organization Name | NORTHWEST GASTROENTEROLOGY CLINIC LLC |
| Practice Address |
1130 Nw 22nd Ave Ste 410 Portland OR 97210-2911 |
| Practice Telephone | 5032297137 |
| Practice Fax Number | 5032410628 |
| Mailing Telephone | 5032297137 |
| Mailing Fax Number | 5032410628 |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2015-06-15 |
| Authorized Official Name | DR. ROLAND WILLIAM BENNETTS (PARTNER) |
| Authorized Official Telephone | 5032297137 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | Other Service Providers |
| Street Address |
1130 NW 22ND AVE STE 410 |
| City | PORTLAND |
| State | OR |
| Zip Code | 97210-2911 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841290699 | Ronald J. Hapke | Internal Medicine | 1130 Nw 22nd Ave Ste 410, Portland, OR 97210-2911 | 2005-07-22 |
| 1750538146 | Maria Nina Villarreal | Registered Nurse | 1130 Nw 22nd Ave Ste 410, Portland, OR 97210-2911 | 2008-08-27 |
| 1942417118 | Saad Fahmi Jazrawi | Specialist | 1130 Nw 22nd Ave Ste 410, Portland, OR 97210-2911 | 2007-05-17 |
| 1801018122 | Katherine Rollins Black | Internal Medicine | 1130 Nw 22nd Ave Ste 410, Portland, OR 97210-2911 | 2007-05-03 |
| 1831315829 | Erich David Vorlop | Internal Medicine | 1130 Nw 22nd Ave Ste 410, Portland, OR 97210-2911 | 2007-04-18 |
| 1366529638 | Ngc Endoscopy Services LLC | Clinic/Center | 1130 Nw 22nd Ave Ste 410, Portland, OR 97210-2911 | 2006-11-01 |
| 1962590570 | Matthew Andres Smith | Internal Medicine | 1130 Nw 22nd Ave Ste 410, Portland, OR 97210-2911 | 2006-10-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679109086 | Joseph Francolino | Massage Therapist | 2174 Nw Davis Street, Apartment 105, Portland, OR 97210 | 2020-03-17 |
| 1215574058 | Northwest Dbt LLC | Psychologist | 2230 Nw Pettygrove St., Suite 130, Portland, OR 97210 | 2019-11-27 |
| 1649769480 | Dipesh Patel | Student in an Organized Health Care Education/Training Program | 1200 Nw 23rd Ave. Legacy Clinic Good Samaritan, Portland, OR 97210 | 2018-05-08 |
| 1760987234 | Meghan Teague | Student in an Organized Health Care Education/Training Program | Legacy Good Samaritan Medical Center- Gme, 1015 Nw 22nd Ave, Portland, OR 97210 | 2018-03-27 |
| 1205349172 | Paul M Storm | Acupuncturist | 1708 Nw 25th Ave. Apt. #6, Portland, OR 97210 | 2017-11-14 |
| 1740703750 | Audra K Berning | Massage Therapist | 2122 Nw Quimby, Root Whole Body, Portland, OR 97210 | 2017-07-21 |
| 1720539810 | Anna-marie Elizabeth Wood | Audiologist | 2222 Nw Lovejoy St Ste 662, Portland, OR 97210 | 2016-10-24 |
| 1659829836 | H&s Pearl, LLC | Massage Therapist | 25 Nw 23rd Pl, Suite 7, Portland, OR 97210 | 2016-09-15 |
| 1255785796 | Cortez Natural Medicine, Inc. | Acupuncturist | 2230 Nw Pettygove Street, Unit 130, Portland, OR 97210 | 2016-04-21 |
| 1932563616 | Vincent Chen | Student in an Organized Health Care Education/Training Program | 1200 Nw 23rd Avenue, Legacy Clinic Good Samaritan, Portland, OR 97210 | 2016-04-08 |
| Find all providers in zip 97210 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215536560 | Irina A Mcgaughey | Specialist | 610 Sw Alder St Ste 920, Portland, OR 97205-3610 | 2020-10-19 |
| 1780294181 | Cynthia R Mendoza | Specialist | 2245 Se Powell Blvd, Portland, OR 97202-2143 | 2020-07-31 |
| 1679199335 | Alter Image, Inc. | Specialist | 2340 Se Gladstone St, Portland, OR 97202-2962 | 2020-06-18 |
| 1770044281 | Donnissa Smith | Specialist | 117 Se 129th Ave, Portland, OR 97233-1503 | 2019-03-27 |
| 1588191258 | Jason Moore | Specialist | 522 Ne Thompson St, Portland, OR 97212-3843 | 2017-05-12 |
| 1578097218 | Alicia N Keys | Specialist | 10480 Sw Eastridge St Apt 88, Portland, OR 97225-5047 | 2017-04-19 |
| 1942734736 | Mom By Lj | Specialist | 2906 N Willamette Blvd, Portland, OR 97217-4073 | 2017-04-18 |
| 1659811198 | Ricardo H. Medina | Specialist | 1400 Nw Irving St Apt 709, Portland, OR 97209-2260 | 2017-03-02 |
| 1730626805 | Jennifer Frank | Specialist | 1008 Se 112th Ave, Portland, OR 97216-3516 | 2017-01-26 |
| 1720523012 | Andrea Lett | Specialist | 4627 Ne 30th Ave, Portland, OR 97211-7001 | 2016-12-22 |
| Find all providers in PORTLAND | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.