NORTHWEST PRIMARY CARE GROUP, PC

Provider Demographics

• NPI: 1558572180
• Name: NORTHWEST PRIMARY CARE GROUP, PC
• Entity Type: Organization
• Organization Name: NORTHWEST PRIMARY CARE GROUP, PC
• Authorized Official - Title/Position: ADMINISTRATOR
• Authorized Official - First Name: MICHAEL
• Authorized Official - Last Name: WHITBECK
• Authorized Official - Phone: 503-659-4777
• Mailing Address - Street 1: PO BOX 22075
• Mailing Address - City: MILWAUKIE
• Mailing Address - State: OR
• Mailing Address - Zip Code: 97269-2075
• Mailing Address - Country: US
• Mailing Address - Phone: 503-659-4777
• Mailing Address - Fax: 503-652-5223
• Practice Address - Street 1: 12300 SE MALLARD WAY
• Practice Address - Street 2: SUITE 160
• Practice Address - City: MILWAUKIE
• Practice Address - State: OR
• Practice Address - Zip Code: 97222-4616
• Practice Address - Country: US
• Practice Address - Phone: 503-659-4777
• Practice Address - Fax: 503-652-5223
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2007-05-25
• Last Update Date: 2020-06-03

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	207Q00000X	Allopathic & Osteopathic Physicians	Family Medicine		Group - Multi-Specialty
No	133V00000X	Dietary & Nutritional Service Providers	Dietitian, Registered		Group - Multi-Specialty
No	207R00000X	Allopathic & Osteopathic Physicians	Internal Medicine		Group - Multi-Specialty
No	225100000X	Respiratory, Developmental, Rehabilitative and Restorative Service Providers	Physical Therapist		Group - Multi-Specialty
No	225X00000X	Respiratory, Developmental, Rehabilitative and Restorative Service Providers	Occupational Therapist		Group - Multi-Specialty
No	261QS1200X	Ambulatory Health Care Facilities	Clinic/Center	Sleep Disorder Diagnostic	Group - Multi-Specialty
No	332B00000X	Suppliers	Durable Medical Equipment & Medical Supplies
No	363A00000X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant		Group - Multi-Specialty
No	363LF0000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Family	Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
OR	230426	Medicaid
OR	049072	Medicaid
OR	226666	Medicaid
OR	38D0624619	Other	CLIA
OR	38D1059196	Other	CLIA
OR	500620284	Medicaid
OR	CE8055	Other	RAILROAD GROUP PTAN
OR	022990	Medicaid
OR	500620283	Medicaid
OR	38D0624596	Other	CLIA
OR	226667	Medicaid
OR	274689	Medicaid
OR	38D0888269	Other	CLIA
OR	226666	Medicaid
OR	0542370004	Medicare NSC
OR	0542370005	Medicare NSC
OR	38D1059196	Other	CLIA
OR	022990	Medicaid
OR	0542370003	Medicare NSC
OR	500620284	Medicaid
OR	132126	Medicare PIN