Providence Health & Services Oregon
NPI 1104097906 · Pediatrics Physician · Longview, WA
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Provider details
- NPI number
- 1104097906
- Entity type
- Organization
- Primary specialty
- Pediatrics PhysicianAllopathic & Osteopathic Physicians
- Parent organization
- Providence Health & Services - Oregon
- Organization subpart
- Yes
- Authorized official
- Donald Anderson, Assistant Secretary of Enrollments(425) 358-9786
Specialties & taxonomies
Allopathic & Osteopathic Physicians
- Clinic/Center261Q00000X
Ambulatory Health Care Facilities
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
18 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Other names (DBA / former)
- Doing business as
- Prov Peds Neurology Longview
- Doing business as
- Providence Medical Group
Registry dates
- Enumerated
- 2008-03-19
- Last updated
- 2025-06-20
- Certified
- 2025-06-20
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.