OrganizationActive
Fanno Creek Clinic LLC
NPI 1609876705 · Internal Medicine Physician · Portland, OR
Provider details
- NPI number
- 1609876705
- Entity type
- Organization
- Primary specialty
- Internal Medicine PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Larry Reed, Clinic Manager(503) 452-0915
- License
- 2802 (OR)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
Detailed profile(91/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
20 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
2400 Sw Vermont St
Portland, OR 97219-1940
Phone: (503) 452-0915
Fax: (503) 768-9232
Street-level locationGet directions
Mailing address
2400 Sw Vermont St
Portland, OR 97219-1940
Registry dates
- Enumerated
- 2005-07-29
- Last updated
- 2007-10-16
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.