Active NPI 1720344732 Individual Practitioner Male Practitioner

Dr. Jonathon M Thorp , MD

Internal Medicine • Tamuning, GU

✓ Accepts Medicare Assignment Telehealth Available

Professional Overview & Biography Verified Profile Summary

Dr. Jonathon Thorp, MD is a certified Internal Medicine practicing in Tamuning, GU. With approximately 14 years of clinical experience since graduating from Loma Linda University School Of Medicine in 2012, Dr. Thorp delivers high-quality medical care to the local community at 388 YPAO RD.

Dr. Thorp maintains professional affiliations with General Conference Corp Of Sda, Portland Adventist Medical Center and accepts Medicare assignment . Telehealth and virtual consultation options are available for eligible patients.

Frequently performed procedures and clinical services include established patient outpatient office visit, insertion of needle into vein for collection of blood sample, administration of influenza virus vaccine. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

388 Ypao Rd

Tamuning, GU 969133701

Telephone 6716468881

Associated Practice Facility / Clinic

🏢 General Conference Corp Of Sda Facility NPI 1275586877

Medicare Profile & Education

Medical School

Loma Linda University School Of Medicine

Graduation Year

2012

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

Telehealth Services Available

Specialty Benchmarks & Practice Insights

Comparative analytics for Internal Medicine in Tamuning, GU

Established Specialist (10-20 Yrs)

Practitioner Clinical Experience

14 Yrs -20.3 yrs vs City Avg

City Avg: 34.3 Yrs

State Avg: 27.1 Yrs

Regional Practice Density

13 Specialists

Practicing in Tamuning, GU (29 Statewide)

Telehealth Adoption Rate

7.7% Regional Adoption

✓ Offers Virtual Consultations

Medicare Pricing Discount

45.7% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Thorp (14 Years) 14 Yrs

Tamuning Specialty Average (34.3 Years) 34.3 Yrs

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2024)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	704	257	$199.05	$132.99
36415 Insertion of needle into vein for collection of blood sample	663	280	$14.21	$8.59
G0008 Administration of influenza virus vaccine	524	505	$32.79	$32.11
80061 Blood test, lipids (cholesterol and triglycerides)	388	207	$81.68	$13.11
90662 Influenza vaccine split virus, preservative free	383	380	$90.47	$81.61
80053 Blood test, comprehensive group of blood chemicals	327	205	$44.10	$10.27
G2211 Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's	305	179	$16.62	$16.70
83036 Hemoglobin A1C level	260	145	$55.79	$9.47
85025 Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count	234	144	$31.49	$7.58
90480 Admn sarscov2 vacc 1 dose	219	209	$47.87	$44.21
91320 Sarscv2 vac 30mcg trs-suc im	216	206	$157.20	$140.71
80048 Blood test, basic group of blood chemicals (calcium, total)	204	126	$37.80	$8.25
G0009 Administration of pneumococcal vaccine	202	202	$32.82	$32.11
90677 Pneumococcal conjugate vaccine, 20 valent (pcv20), for intramuscular use	188	188	$346.40	$287.63
84443 Blood test, thyroid stimulating hormone (TSH)	119	79	$90.90	$16.33
82306 Vitamin d-3 level	115	91	$184.50	$28.43
99213 Established patient office or other outpatient visit, typically 15 minutes	113	90	$135.00	$95.40
90688 Vaccine for influenza for administration into muscle, 0.5 ml dosage	101	101	$34.20	$20.46
83880 Natriuretic peptide (heart and blood vessel protein) level	93	50	$149.28	$38.27
83735 Magnesium level	92	60	$35.10	$6.57
77067 Screening mammography	83	83	$239.40	$106.81
99490 Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month	72	47	$88.47	$66.17
84550 Uric acid level, blood	65	41	$25.20	$4.43
82570 Creatinine level to test for kidney function or muscle injury	64	52	$40.47	$5.08
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	64	64	$185.85	$139.04
82043 Urine microalbumin (protein) level	63	52	$61.20	$5.66
G0444 Annual depression screening, 5 to 15 minutes	62	62	$27.42	$20.94
85610 Blood test, clotting time	58	25	$21.60	$4.20
81001 Manual urinalysis test with examination using microscope, automated	52	40	$27.00	$3.11
90658 Influenza vaccine, trivalent, 0.5 ml dosage	46	46	$36.27	$20.95
84439 Thyroxine (thyroid chemical), free	42	33	$88.20	$8.76
93000 Routine ekg using at least 12 leads including interpretation and report	30	28	$53.46	$15.07
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	30	18	$41.40	$25.88
82607 Cyanocobalamin (vitamin B-12) level	28	26	$90.00	$14.78
99439 Chronic care management services for two or more chronic conditions, additional 20 minutes of clinical staff time directed by health care professional, per calendar month	27	13	$67.85	$51.14
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	24	20	$280.80	$189.28
G0328 Colorectal cancer screening; fecal occult blood test, immunoassay, 1-3 simultaneous	23	23	$35.03	$17.69
84100 Phosphate level	22	21	$23.40	$4.56
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	20	20	$82.05	$59.50
82728 Ferritin (blood protein) level	17	15	$72.00	$13.36
76641 Complete ultrasound scan of 1 breast	17	16	$250.72	$98.01
71046 X-ray of chest, 2 views	16	16	$56.70	$26.42
85027 Complete blood cell count (red cells, white blood cell, platelets), automated test	15	15	$28.80	$6.09
99495 Transitional care management services for problem of at least moderate complexity	14	11	$295.18	$222.01
76536 Ultrasound of head and neck	14	13	$194.40	$96.98
85651 Red blood cell sedimentation rate, to detect inflammation, non-automated	12	12	$17.10	$4.18
90732 Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older	12	12	$160.17	$130.80

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
36415 Insertion of needle into vein for collection of blood sample	604	295	$15.30	$8.31
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	513	269	$190.84	$132.06
G0008 Administration of influenza virus vaccine	377	376	$32.83	$32.67
80061 Blood test, lipids (cholesterol and triglycerides)	330	206	$79.18	$13.08
90688 Vaccine for influenza for administration into muscle, 0.5 ml dosage	262	261	$31.50	$20.30
83036 Hemoglobin A1C level	244	151	$54.00	$9.43
80048 Blood test, basic group of blood chemicals (calcium, total)	223	143	$37.80	$8.24
80053 Blood test, comprehensive group of blood chemicals	221	169	$44.10	$10.35
99213 Established patient office or other outpatient visit, typically 15 minutes	206	151	$138.60	$95.17
85025 Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count	169	117	$30.60	$7.58
90662 Influenza vaccine split virus, preservative free	115	115	$83.93	$70.68
82306 Vitamin d-3 level	115	93	$184.50	$28.59
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	115	115	$190.19	$138.07
G0444 Annual depression screening, 5 to 15 minutes	113	113	$27.50	$20.19
84443 Blood test, thyroid stimulating hormone (TSH)	102	76	$90.87	$16.46
99490 Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month	87	57	$91.04	$65.36
G0009 Administration of pneumococcal vaccine	85	85	$32.38	$32.06
77067 Screening mammography	73	73	$220.65	$107.70
82570 Creatinine level to test for kidney function or muscle injury	71	58	$38.70	$4.94
83735 Magnesium level	71	50	$35.10	$6.57
82043 Urine microalbumin (protein) level	70	58	$61.20	$5.58
90677 Pneumococcal conjugate vaccine, 20 valent (pcv20), for intramuscular use	69	69	$293.16	$282.82
83880 Natriuretic peptide (heart and blood vessel protein) level	53	37	$144.00	$38.47
84550 Uric acid level, blood	52	34	$25.20	$4.38
85610 Blood test, clotting time	51	30	$21.60	$4.20
81001 Manual urinalysis test with examination using microscope, automated	36	29	$24.30	$3.05
G0328 Colorectal cancer screening; fecal occult blood test, immunoassay, 1-3 simultaneous	35	35	$45.39	$17.69
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	35	22	$40.50	$25.80
84100 Phosphate level	34	30	$23.40	$4.57
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	29	27	$88.07	$59.49
82728 Ferritin (blood protein) level	27	18	$72.00	$13.36
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	23	23	$297.00	$175.54
93000 Routine ekg using at least 12 leads including interpretation and report	21	19	$55.80	$15.15
91320 Sarscv2 vac 30mcg trs-suc im	21	21	$132.25	$128.48
90480 Admn sarscov2 vacc 1 dose	21	21	$47.51	$43.53
G0442 Annual alcohol misuse screening, 5 to 15 minutes	21	21	$28.03	$19.40
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	19	17	$267.49	$189.51
76641 Complete ultrasound scan of 1 breast	18	16	$201.60	$87.09
85044 Red blood count, manual test	18	14	$18.00	$4.22
84439 Thyroxine (thyroid chemical), free	17	14	$86.40	$8.84
77065 Diagnostic mammography of 1 breast	16	16	$211.16	$97.21
90732 Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older	16	16	$160.16	$130.80
99439 Chronic care management services for two or more chronic conditions, additional 20 minutes of clinical staff time directed by health care professional, per calendar month	16	14	$69.32	$50.37
G0181 Physician or allowed practitioner supervision of a patient receiving medicare-covered services provided by a participating home health agency (patient not present) requiring complex and multidisciplinary care modalities involving regular physician or allow	15	12	$215.59	$109.52
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	15	15	$205.74	$118.78
71046 X-ray of chest, 2 views	14	14	$53.74	$27.07
76705 Limited ultrasound scan of abdomen	14	14	$154.86	$67.28
82746 Folic acid level	12	11	$86.40	$14.41

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
36415 Insertion of needle into vein for collection of blood sample	644	278	$15.30	$2.97
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	531	238	$187.71	$135.10
80053 Blood test, comprehensive group of blood chemicals	416	234	$44.10	$10.33
80061 Blood test, lipids (cholesterol and triglycerides)	408	230	$76.50	$13.13
83036 Hemoglobin A1C level	286	151	$54.00	$9.49
99213 Established patient office or other outpatient visit, typically 15 minutes	237	155	$131.62	$95.24
85025 Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count	202	132	$30.60	$7.67
G0008 Administration of influenza virus vaccine	188	186	$30.04	$30.00
82306 Vitamin d-3 level	153	111	$184.50	$28.60
82043 Urine microalbumin (protein) level	145	98	$61.20	$5.75
82570 Creatinine level to test for kidney function or muscle injury	143	99	$37.80	$5.12
84443 Blood test, thyroid stimulating hormone (TSH)	139	97	$88.20	$16.60
90662 Influenza vaccine split virus, preservative free	126	126	$76.93	$68.54
80048 Blood test, basic group of blood chemicals (calcium, total)	121	72	$37.80	$8.29
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	78	78	$192.26	$141.58
G0444 Annual depression screening, 5 to 15 minutes	76	76	$27.73	$20.47
85610 Blood test, clotting time	68	38	$21.60	$4.24
99490 Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month	67	49	$80.93	$67.50
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	62	36	$40.50	$25.43
90688 Vaccine for influenza for administration into muscle, 0.5 ml dosage	62	61	$31.50	$19.96
83735 Magnesium level	57	39	$35.10	$6.62
G0009 Administration of pneumococcal vaccine	51	51	$26.30	$25.66
77067 Screening mammography	50	50	$216.90	$109.01
83880 Natriuretic peptide (heart and blood vessel protein) level	43	28	$142.20	$38.64
G0328 Colorectal cancer screening; fecal occult blood test, immunoassay, 1-3 simultaneous	41	41	$49.15	$17.86
84550 Uric acid level, blood	41	29	$24.30	$4.45
84439 Thyroxine (thyroid chemical), free	41	31	$79.20	$8.93
85651 Red blood cell sedimentation rate, to detect inflammation, non-automated	36	23	$17.10	$4.15
81001 Manual urinalysis test with examination using microscope, automated	35	28	$24.30	$3.02
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	33	32	$83.79	$60.29
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	33	33	$288.78	$174.90
G0442 Annual alcohol misuse screening, 5 to 15 minutes	32	32	$27.73	$20.85
90732 Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older	31	31	$144.47	$129.27
76641 Complete ultrasound scan of 1 breast	29	21	$196.63	$87.48
93000 Routine ekg using at least 12 leads including interpretation and report	28	24	$54.28	$15.61
84100 Phosphate level	27	24	$21.60	$4.58
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	25	23	$260.23	$189.80
99439 Chronic care management services for two or more chronic conditions, additional 20 minutes of clinical staff time directed by health care professional, per calendar month	25	20	$61.62	$51.32
G0438 Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit	25	25	$248.10	$180.63
0064A Adm sarscov2 50mcg/0.25mlbst	24	24	$40.00	$40.39
77065 Diagnostic mammography of 1 breast	18	17	$210.60	$103.47
84153 Psa (prostate specific antigen) measurement, total	18	16	$93.60	$17.66
71046 X-ray of chest, 2 views	17	15	$53.10	$27.21
99406 Smoking and tobacco use intermediate counseling, greater than 3 minutes up to 10 minutes	16	13	$27.00	$16.55
85044 Red blood count, manual test	16	13	$18.90	$4.27
90670 Pneumococcal vaccine for injection into muscle	16	16	$276.17	$249.99
Q3014 Telehealth originating site facility fee	14	13	$29.13	$26.52
82728 Ferritin (blood protein) level	11	11	$72.00	$13.36
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	11	11	$189.00	$120.79

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
36415 Insertion of needle into vein for collection of blood sample	337	202	$15.30	$3.00
G0008 Administration of influenza virus vaccine	222	221	$30.60	$18.59
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	214	126	$190.89	$134.43
80053 Blood test, comprehensive group of blood chemicals	197	154	$45.90	$10.54
80061 Blood test, lipids (cholesterol and triglycerides)	179	151	$74.70	$13.35
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	178	178	$284.30	$171.53
85025 Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count	146	112	$31.50	$7.68
83036 Hemoglobin A1C level	129	104	$54.90	$9.62
90688 Vaccine for influenza for administration into muscle, 0.5 ml dosage	119	119	$34.96	$19.90
90662 Influenza vaccine split virus, preservative free	103	103	$73.18	$64.63
84443 Blood test, thyroid stimulating hormone (TSH)	100	89	$87.30	$16.80
99213 Established patient office or other outpatient visit, typically 15 minutes	90	63	$119.37	$94.95
82043 Urine microalbumin (protein) level	84	67	$62.10	$5.78
82570 Creatinine level to test for kidney function or muscle injury	84	67	$36.00	$5.08
80048 Blood test, basic group of blood chemicals (calcium, total)	75	47	$38.70	$8.37
85610 Blood test, clotting time	70	42	$20.70	$4.29
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	70	70	$189.35	$117.21
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	61	35	$40.50	$25.32
82306 Vitamin d-3 level	61	56	$182.70	$29.13
77067 Screening mammography	42	42	$216.90	$110.31
0003A Adm sarscov2 30mcg/0.3ml 3rd	31	31	$40.00	$40.00
83735 Magnesium level	29	24	$35.10	$6.70
85651 Red blood cell sedimentation rate, to detect inflammation, non-automated	29	15	$18.00	$4.27
84439 Thyroxine (thyroid chemical), free	29	26	$72.00	$9.02
93000 Routine ekg using at least 12 leads including interpretation and report	28	25	$49.00	$15.37
G0009 Administration of pneumococcal vaccine	24	24	$26.96	$18.58
G0328 Colorectal cancer screening; fecal occult blood test, immunoassay, 1-3 simultaneous	21	21	$37.83	$18.05
76641 Complete ultrasound scan of 1 breast	21	15	$168.30	$83.19
99205 New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more	19	19	$363.60	$235.14
81001 Manual urinalysis test with examination using microscope, automated	18	17	$23.40	$3.17
G0444 Annual depression screening, 5 to 15 minutes	17	17	$27.00	$20.54
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	17	17	$169.51	$141.72
84100 Phosphate level	16	16	$20.70	$4.74
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	16	15	$74.81	$60.94
84550 Uric acid level, blood	15	12	$24.30	$4.52
90732 Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older	13	13	$143.90	$125.46
0002A Intramuscular administration of single severe acute respiratory syndrome coronavirus 2 (covid-19) vaccine, mrna-lnp, spike protein, preservative free, 30 mcg/0.3ml dosage, diluent reconstituted; second dose	12	12	$39.03	$39.03
0001A Intramuscular administration of single severe acute respiratory syndrome coronavirus 2 (covid-19) vaccine, mrna-lnp, spike protein, preservative free, 30 mcg/0.3ml dosage, diluent reconstituted; first dose	12	12	$38.78	$38.78
90670 Pneumococcal vaccine for injection into muscle	11	11	$276.17	$241.38

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	11	11	$233.00	$110.47

Medical Specialties & State Licenses

CMS Verified: 2021-09-14

Internal Medicine Primary Specialty

NUCC Taxonomy Code: 207R00000X

State License GU M-2218

A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

Internal Medicine

NUCC Taxonomy Code: 207R00000X

State License MD M84011

Internal Medicine

NUCC Taxonomy Code: 207R00000X

State License OR MD176634

Hospitalist

NUCC Taxonomy Code: 208M00000X

State License GU M-2218

Hospitalists are physicians whose primary professional focus is the general medical care of hospitalized patients. Their activities include patient care, teaching, research, and leadership related to Hospital Medicine. The term 'hospitalist' refers to physicians whose practice emphasizes providing care for hospitalized patients.

Student in an Organized Health Care Education/Training Program

NUCC Taxonomy Code: 390200000X

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

Hospital & Practice Group Affiliations

Portland Adventist Medical Center

10151 Se Sunnyside Rd, Clackamas, OR 970155705

Phone: 5036590880

General Conference Corp Of Sda

388 Ypao Rd, Tamuning, GU 969133701

Phone: 6716468881

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

40 Associated Practitioners

Diane Hiatt , FNP

Nurse Practitioner - Family

NPI 1013068485

Family Nurse Practitioner

Rachel Magistre-Legend , PA-C

Physician Assistant

NPI 1013117175

Physician Assistant (Certified)

Jessica Gow-Lee , CNM

Advanced Practice Midwife

NPI 1013134345

Certified Nurse Midwife

Dr. Jonathan Visscher , DDS

Dentist - General Practice

NPI 1053560565

Doctor of Dental Surgery

Alison Chong , FNP

Nurse Practitioner - Family

NPI 1073111712

Family Nurse Practitioner

Dr. Nilmini Pang , MD

Family Medicine

NPI 1083292189

Doctor of Medicine (M.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

11 Historical Events

📍

Updated Practice Location September 29, 2021

Registered at 388 YPAO RD, TAMUNING, GU 969133701 (Tel: 6716468881)

📍

Updated Business Mailing Address September 29, 2021

Registered at 17131 SE ROYER RD, DAMASCUS, OR 970898746 (Tel: 6714878483)

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) September 29, 2021

Internal Medicine (License #M84011 in MD)

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) September 01, 2021

Student in an Organized Health Care Education/Training Program

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) August 13, 2020

Internal Medicine (License #M-2218 in GU)

✅

NPI Profile Active April 03, 2012

NPI status registered as active in NPPES database

📍

Updated Practice Location April 03, 2012

Registered at 5200 EASTERN AVE, MASON F. LORD BUILDING CENTER TOWER 3RD FLOOR, ROOM 326, BALTIMORE, MD 212242734 (Tel: 4105500530)

📍

Updated Business Mailing Address April 03, 2012

Registered at 1036 MEANDERING WAY, ODENTON, MD 211133686 (Tel: 9097096906)

👤

Provider Name / Credentials Updated April 03, 2012

Recorded as JONATHON THORP, M.D.

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) April 03, 2012

Student in an Organized Health Care Education/Training Program

🟢

Initial NPI Registration & Enumeration April 03, 2012

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

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NPI Administrative Meta

NPI Number: 1720344732

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: April 03, 2012

Last Update: September 29, 2021

Sole Proprietor: Yes

Update or Correct Profile

Mailing Address

17131 Se Royer Rd

Damascus, OR 970898746

Phone: 6714878483

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.