ETHAN CHAUNCEY KORNGOLD MD
NPI 1568452738
Internal Medicine - Interventional Cardiology in Portland, OR
NPI Status: Active since October 27, 2005
Contact Information
9427 SW BARNES RD
SUITE 498
PORTLAND, OR
ZIP 97225
Phone: (503) 216-0900
- Individual
- Male
- Years of Experience 25
- Internal Medicine
- Interventional Cardiology
- Accepts Medicare Approved Payment
- PECOS Enrolled
About ETHAN KORNGOLD
This page provides the complete NPI Profile along with additional information for Ethan Korngold, an internist established in Portland, Oregon with a medical specialization in Internal Medicine, focusing in interventional cardiology and more than 25 years of experience. He graduated from Washington University School Of Medicine in 2001. The healthcare provider is registered in the NPI registry with number 1568452738 assigned on October 2005. The practitioner's primary taxonomy code is 207RI0011X with license number MD29224 (OR). The provider is registered as an individual and his NPI record was last updated 4 years ago.
- NPI
- 1568452738
- Provider Name
- ETHAN CHAUNCEY KORNGOLD MD
- Gender
- Male
- Entity Type
- Individual
- Location Address
- 9427 SW BARNES RD SUITE 498 PORTLAND, OR 97225
- Location Phone
- (503) 216-0900
- Mailing Address
- PO BOX 3158 PORTLAND, OR 97208
- Medical School Name
- WASHINGTON UNIVERSITY SCHOOL OF MEDICINE
- Graduation Year
- 2001
- Is Sole Proprietor?
- No
- Enumeration Date
- 10-27-2005
- Last Update Date
- 03-19-2021
- Code Navigator
An internist like Ethan Korngold is a physician who has completed an internal medicine residency and is board-certified or board-eligible in an internist specialty. Internists are trained to care for adults of all ages for many different medical conditions. An internist typically monitors chronic physical conditions, identifies acute diseases, provides family planning, provides counseling about wellness and disease prevention, etc.
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Internal Medicine Interventional Cardiology
- Taxonomy Code
- 207RI0011X
- Type
- Allopathic & Osteopathic Physicians
- License No.
- MD29224
- License State
- OR
- Taxonomy Description
- An area of medicine within the subspecialty of cardiology, which uses specialized imaging and other diagnostic techniques to evaluate blood flow and pressure in the coronary arteries and chambers of the heart and uses technical procedures and medications to treat abnormalities that impair the function of the cardiovascular system.
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
---|---|---|---|---|
1 | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | 217916 (MA) |
2 | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | 217916 (MA) |
3 | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | MD29224 (OR) |
4 | 207RI0011X | Allopathic & Osteopathic Physicians | Internal Medicine | MD60107167 (WA) |
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
Identifier | Type / Code | Identifier State | Identifier Issuer |
---|---|---|---|
P00848656 | OTHER (01) | OR | RR MEDICARE |
500609355 | MEDICAID (05) | OR |
Medicare Participation & PECOS Enrollment Status
Ethan Korngold is registered with Medicare and accepts claims assignment, this means the provider accepts the approved amount for the cost of rendered services as full payment. Participating providers may not charge beneficiaries more than the approved amount for their services. Please keep in mind that beneficiaries still have to pay a coinsurance or copayment amount for a visit or service.
Ethan Korngold is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.
What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.
Is the provider registered in PECOS? Yes
PECOS PAC ID: 345248464
What is the PECOS Associate Control ID?
A PAC ID is a unique 10-digit number assigned to an individual or organization healthcare provider in PECOS. The PAC ID is used to link together all the provider information, like tax identification numbers and organizational names. A PAC ID can be connected to multiple Enrollment IDs if an individual or organization has enrolled in PECOS more than once.PECOS Enrollment ID: I20090826000937
What is the Provider Enrollment ID?
The Enrollment ID is a unique alphanumeric 15-digit code assigned to each new provider's PECOS enrollment application. The Enrollment ID is used to link together all the provider enrollment information like enrollment type, state, provider specialty, and reassignment of benefits.Accepts Medicare Assignment? Yes
What does it mean "accepts medicare assignment"?
When a provider accepts Medicare assignment, the provider agrees to be paid directly by Medicare and to accept the payment amount approved by Medicare. Additionally, the provider agrees to not bill patients for more than the Medicare deductible and coinsurance amounts.
A provider who doesn't accept assignment may charge you up to 15% over the Medicare-approved amount. This is known as the limiting charge. You may have to pay this amount, or it may be covered by another insurer.Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes
Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes
Eligible to Order or Refer a Home Health Agency (HHA): Yes
Eligible to Order or Refer Power Mobility Devices: Yes
Areas of Expertise
The following services and procedures, recently provided to Medicare patients, illustrate the range of care this provider offers. This list reflects the variety of services available to all patients visiting the practice and is based on 2022 Medicare dataset. In general, the more frequently a provider treats specific conditions or performs particular procedures, the more experienced they become in addressing similar patient needs. The provider has delivered many of the services listed below to Medicare patients. Please note that this list does not include services provided to patients who are not covered by Medicare.
Complete ultrasound of abdomen and pelvis artery and vein blood flow
Coronary angioplasty and stenting
Established patient office or other outpatient visit, 30-39 minutes
Established patient office or other outpatient visit, 40-54 minutes
Initial hospital inpatient care per day, typically 70 minutes
Insertion of stents with balloon dilation of coronary artery or branch, single artery or branch
Insertion of tube in coronary artery for diagnosis with review by radiologist
Insertion of tube in left lower heart chamber and coronary artery for diagnosis with review by radiologist
Leg revascularization (restoring blood flow)
New patient office or other outpatient visit, 45-59 minutes
New patient office or other outpatient visit, 60-74 minutes
Pacemaker insertion or repair
Replacement of aortic valve through the skin and femoral artery
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only
Routine electrocardiogram (ecg) using at least 12 leads with tracing
Ultrasound evaluation of heart blood vessel or graft with review by radiologist, initial vessel
Ultrasound of both sides of head and neck blood flow
Ultrasound of leg arteries or artery grafts
Ultrasound of one leg arteries or artery grafts
Ultrasound study of arm and leg arteries
Ultrasound study of arm or leg veins with compression and maneuvers
Ultrasound study of one arm or leg veins with compression and maneuvers
Use of a drug to induce depression of consciousness by physician performing a procedure (5 years or older), initial 15 minutes
This procedure uses sound waves to create images of your abdomen and pelvis, specifically focusing on the arteries and veins. It helps in assessing the blood flow and detecting any abnormalities, ensuring your overall well-being.
This service was performed 12 times for 12 patientsCoronary angioplasty and stenting is a procedure to open narrowed or blocked heart arteries. A thin tube is inserted into a blood vessel, usually in the leg or arm, and guided to the heart. A small balloon at the end of the tube is inflated to widen the artery. A stent, a small wire mesh tube, may be placed in the artery to keep it open.
This service was performed for 47 patientsThis is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
This service was performed 27 times for 26 patientsThis service involves a follow-up appointment for existing patients, lasting between 40 to 54 minutes. During this time, your healthcare provider will assess your current health status, discuss any changes or concerns, review your treatment plan, and answer any questions you may have.
This service was performed 48 times for 44 patientsInitial hospital inpatient care per day, typically 70 minutes, refers to the daily medical service provided to patients admitted to the hospital. This includes a comprehensive evaluation, diagnosis, treatment plan, and monitoring of your health condition. It ensures your well-being during your hospital stay.
This service was performed 17 times for 17 patientsThis procedure involves placing a small, mesh tube (stent) in your coronary artery to keep it open. A balloon is used to expand the stent and artery, improving blood flow to your heart. It's typically done for a single artery or branch.
This service was performed 15 times for 13 patientsThis procedure involves placing a small tube into your coronary artery. It helps to identify any blockages or issues within the artery. A radiologist, a doctor specialized in medical imaging, will review the results to ensure accurate diagnosis.
This service was performed 24 times for 24 patientsThis procedure involves placing a tube into your left lower heart chamber and coronary artery. It helps doctors diagnose heart conditions by allowing them to view these areas in detail. A radiologist will review the images to ensure accurate diagnosis.
This service was performed 21 times for 21 patientsLeg revascularization is a procedure aimed at restoring proper blood flow to your legs. It's often needed when blood vessels in your legs are blocked or narrowed. The process may involve surgery or less invasive methods to remove or bypass blockages, helping to alleviate pain and prevent serious complications.
This service was performed for 17 patientsThis is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.
This service was performed 21 times for 21 patientsThis is a first-time patient visit where a healthcare professional spends 60-74 minutes with you. It involves a comprehensive evaluation, including your medical history and current health condition. They'll also advise on preventive health measures and formulate a treatment plan if needed.
This service was performed 57 times for 57 patientsPacemaker insertion or repair is a procedure to help regulate your heartbeat. A small device, called a pacemaker, is implanted under the skin near your heart. This device sends electrical signals to prompt your heart to beat at a normal rate. In a repair procedure, the pacemaker may be adjusted, replaced, or the wires connecting it to your heart may be fixed.
This service was performed for 1-10 patientsThis procedure, known as Transcatheter Aortic Valve Replacement (TAVR), involves replacing a damaged aortic valve through a small incision in the leg. A catheter is inserted into the femoral artery and guided up to the heart. The new valve is then positioned and deployed, restoring normal blood flow.
This service was performed 65 times for 64 patientsAn electrocardiogram (ECG) is a non-invasive test that records your heart's electrical activity. Using 12 leads attached to your body, it captures data to help identify heart conditions. A doctor interprets the results and provides a report.
This service was performed 11 times for 11 patientsA routine electrocardiogram (ECG) with 12 leads is a simple, non-invasive test that records the electrical activity of your heart. It helps in identifying heart conditions by detecting irregularities in your heart rhythms. The results are interpreted and a report is provided.
This service was performed 63 times for 57 patientsA routine electrocardiogram (ECG) with 12 leads is a simple, non-invasive test that records the electrical activity of your heart. It helps in identifying heart conditions by detecting irregularities in your heart rhythms. The results are interpreted and a report is provided.
This service was performed 24 times for 24 patientsAn Electrocardiogram (ECG) is a simple, painless test that records the heart's electrical activity. Using 12 leads attached to your skin, it generates a tracing of your heart rhythm. It helps detect any heart problems by showing the timing and strength of electrical signals passing through each part of your heart.
This service was performed 13 times for 13 patientsThis procedure involves using ultrasound technology to examine the first vessel of your heart or graft. A radiologist will review the images. It's a non-invasive way to check the health of your heart's blood vessels.
This service was performed 23 times for 23 patientsAn ultrasound of the head and neck blood flow is a safe, non-invasive procedure that uses sound waves to create images of blood vessels. It helps detect abnormalities like blockages or clots, ensuring optimal blood flow.
This service was performed 32 times for 32 patientsAn ultrasound of leg arteries or artery grafts is a non-invasive imaging test. It uses high-frequency sound waves to capture live images from inside your body, specifically your leg arteries or grafts. This helps in detecting any blockages or abnormalities.
This service was performed 11 times for 11 patientsAn ultrasound of leg arteries or artery grafts is a non-invasive test using sound waves to create images of your blood vessels. This helps doctors assess blood flow, identify blockages, and monitor the health of grafts.
This service was performed 16 times for 16 patientsAn ultrasound study of arm and leg arteries is a non-invasive procedure that uses sound waves to create images of your arteries. It helps in checking blood flow, identifying blockages, or detecting other abnormalities in your arteries.
This service was performed 15 times for 15 patientsAn ultrasound study of arm or leg veins with compression and maneuvers is a non-invasive procedure that uses sound waves to create images of your veins. This helps identify blood clots or other vein problems. During the procedure, pressure is applied to the veins and certain movements are performed to assess blood flow.
This service was performed 31 times for 31 patientsThis is a non-invasive procedure using sound waves to visualize veins in an arm or leg. It involves applying gentle pressure and performing certain movements. It helps identify any abnormal blood flow or clots, ensuring vascular health.
This service was performed 59 times for 59 patientsThis procedure involves a doctor administering a medication to reduce your consciousness during a procedure. This helps in managing discomfort and anxiety. The initial application lasts for 15 minutes and is for individuals aged 5 years or older.
This service was performed 79 times for 77 patientsPhysician Visit Costs
The typical physician office visit costs for Medicare beneficiaries in this area are: $33.54 for a new patient copayment and $25.87 for an established patient copayment.
The pricing information below displays the copayment minimum, maximum and average amount that patients under Medicare are charged when visiting this provider as a new or established patient. Please keep in mind that these prices are just for reference purposes, and the actual prices charged by the provider might be different.
For patients covered under private health plans the prices below are also useful as healthcare pricing for private insurance is usually established as a function of Medicare prices. Private insurance covered patients should check their individual plans to determine the exact pricing.
The prices below reflect the costs for new and established patients in the 97225 ZIP code area.
New Patients Visit Costs *
The most utilized procedure code for new patients office visits is 99204
- Average New Patient Price $134.16
- Minimum New Patient Price $58.99
- Maximum New Patient Price $176.88
- Average New Patient Copayment $33.54
- Minimum New Patient Copayment $14.74
- Maximum New Patient Copayment $44.22
Established Patients Visit Costs *
The most utilized procedure code for established patients office visits is 99214
- Average Established Patient Price $103.51
- Minimum Established Patient Price $19.32
- Maximum Established Patient Price $144.79
- Average Established Patient Copayment $25.87
- Minimum Established Patient Copayment $4.83
- Maximum Established Patient Copayment $36.19
* The physician office visit costs information is generated by statistical analysis of similar providers in the same geographical area. The pricing information above IS NOT the amount charged by this provider.
Find Provider Hospital Affiliations - Privileges
Doctors and physicians must apply for hospital privileges to treat patients at hospitals. Find out if your doctor has privileges to practice at your preferred hospital by using the hospital affiliation information below based on recent medical claims.
Hospital affiliation is identified through self-reporting data, inpatient, outpatient, physician and ancillary service claims linked by the medical claims NPI number and place of service code. Additionally, to further determine provider hospital affiliation the clinician must have provided services to at least three patients on three different dates in the last 12 months. Ethan Korngold is affiliated with the following medical facilities:
Hospital Name | Address | Phone | Hospital Type | Overall Rating |
---|---|---|---|---|
PROVIDENCE ST VINCENT MEDICAL CENTER | 9205 SW BARNES ROAD PORTLAND, OR 97225 | (503) 216-2213 | Acute Care Hospitals |
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NPI Validation Check Digit Calculation
The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.
Start with the original NPI number, the last digit is the check digit and is not used in the calculation. | |||||||||
1 | 5 | 6 | 8 | 4 | 5 | 2 | 7 | 3 | 8 |
Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
2 | 5 | 12 | 8 | 8 | 5 | 4 | 7 | 6 | |
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
2 + 5 + 1 + 2 + 8 + 8 + 5 + 4 + 7 + 6 + 24 = 72 | |||||||||
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
80 - 72 = 8 | 8 |
The NPI number 1568452738 is valid because the calculated check digit 8 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following 20 providers are registered at the same or nearby location.
NPI | Name / Type | Taxonomy | Address |
---|---|---|---|
1407851363 | DR. BERNARD A GASCH MD Individual | Dermatology | 9427 SW BARNES RD SUITE 495 PORTLAND, OR 97225 (503) 297-3440 |
1457357576 | BEATA L RYDZIK MD Individual | Dermatology | 9427 SW BARNES RD SUITE 495 PORTLAND, OR 97225 (503) 297-3440 |
1386636769 | HUBERT A LEONARD MD Individual | Psychiatry & Neurology (Neurology) | 9427 SW BARNES RD SUITE 595 PORTLAND, OR 97225 (503) 216-1150 |
1801869078 | DR. CHARLES M KILO M.D. Individual | Internal Medicine | 9427 SW BARNES RD SUITE 590 PORTLAND, OR 97225 (503) 292-9560 |
1821043126 | CHRISTINE M MALANGO FNP Individual | Nurse Practitioner (Family) | 9427 SW BARNES RD SUITE 395 PORTLAND, OR 97225 (503) 216-2602 |
1104872233 | DR. DAVID ELLIOTT DINE M.D. Individual | Psychiatry & Neurology (Neurology) | 9427 SW BARNES RD SUITE 595 PORTLAND, OR 97225 (503) 297-6976 |
1952342842 | MICHAEL H VAWTER MD Individual | Internal Medicine (Cardiovascular Disease) | 9427 SW BARNES RD STE 498 PORTLAND, OR 97225 (503) 216-0900 |
1962448068 | DONALD W SUTHERLAND MD Individual | Specialist | 9427 SW BARNES RD STE 498 PORTLAND, OR 97225 (503) 297-6234 |
1215973318 | COLUMBIA CARDIOLOGY ASSOCIATES LTD Organization | Specialist | 9427 SW BARNES RD STE 498 PORTLAND, OR 97225 (503) 297-6234 |
1821034398 | SUSAN G BIRKEMEIER MD Individual | Obstetrics & Gynecology | 9427 SW BARNES RD SUITE 395 PORTLAND, OR 97225 (503) 216-2602 |
1699701086 | MICHAEL M KLOTZ MD Individual | Obstetrics & Gynecology | 9427 SW BARNES RD SUITE 395 PORTLAND, OR 97225 (503) 216-2602 |
1295761633 | MARY ALICE HELIKSON MD Individual | Surgery (Pediatric Surgery) | 9427 SW BARNES RD SUITE 598 PORTLAND, OR 97225 (503) 216-8654 |
1134155542 | SUSAN M MITCHELL-MILLER FNP Individual | Nurse Practitioner (Obstetrics & Gynecology) | 9427 SW BARNES RD SUITE 395 PORTLAND, OR 97225 (503) 216-2602 |
1700817053 | ROSE A BLACKWELL MD Individual | Obstetrics & Gynecology | 9427 SW BARNES RD SUITE 395 PORTLAND, OR 97225 (503) 216-2602 |
1720004872 | MITCHELL J STRAUSS MD Individual | Obstetrics & Gynecology | 9427 SW BARNES RD SUITE 395 PORTLAND, OR 97225 (503) 216-2602 |
1205849791 | WAYNE FRANCIS GILBERT M.D. Individual | Surgery | 9427 SW BARNES RD PORTLAND, OR 97225 (503) 203-2040 |
1700899051 | DR. ERIC DAVID EVANS D.P.M Individual | Podiatrist (Foot & Ankle Surgery) | 9427 SW BARNES RD PORTLAND, OR 97225 (503) 203-2040 |
1841303161 | DAVID D LONG MD Individual | Specialist | 9427 SW BARNES RD PORTLAND, OR 97225 (503) 203-2040 |
1821102682 | MR. LAWRENCE THOMAS DENIS JR. P.A.-C. Individual | Physician Assistant | 9427 SW BARNES RD PORTLAND, OR 97225 (503) 203-2040 |
1598879363 | NORMAN FREEMAN M.D. Individual | Psychiatry & Neurology (Neurology) | 9427 SW BARNES RD PORTLAND, OR 97225 (503) 203-2021 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1568452738, enumerated in the NPI registry as an "individual" on October 27, 2005
The provider is located at 9427 Sw Barnes Rd Suite 498 Portland, Or 97225 and the phone number is (503) 216-0900
The provider's speciality is Internal Medicine with taxonomy code 207RI0011X with a focus in Interventional Cardiology
The provider has more than 25 years of experience. He graduated from Washington University School Of Medicine in 2001.
The provider might be accepting Accepts: Railroad Medicare, Medicare and Medicaid. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.
Yes, as of June 20, 2025 the provider is registered in PECOS and is eligible to order health care services or supplies for Medicare patients. If you are a beneficiary the provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.
Medicare beneficiaries should expect a typical cost of $134.16 with an average copayment of $33.54 for new patient appointments. Established patients should expect a typical charge of $103.51 and an average copayment of 25.87. Please review your insurance plan or contact the provider directly to determine your specific costs.
The most common procedures or services performed by this practitioner are: Complete ultrasound of abdomen and pelvis artery and vein blood flow, Coronary angioplasty and stenting, Established patient office or other outpatient visit, 30-39 minutes, Established patient office or other outpatient visit, 40-54 minutes, Initial hospital inpatient care per day, typically 70 minutes, Insertion of stents with balloon dilation of coronary artery or branch, single artery or branch, Insertion of tube in coronary artery for diagnosis with review by radiologist, Insertion of tube in left lower heart chamber and coronary artery for diagnosis with review by radiologist, Leg revascularization (restoring blood flow), New patient office or other outpatient visit, 45-59 minutes, New patient office or other outpatient visit, 60-74 minutes, Pacemaker insertion or repair, Replacement of aortic valve through the skin and femoral artery, Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report, Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only, Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only, Routine electrocardiogram (ecg) using at least 12 leads with tracing, Ultrasound evaluation of heart blood vessel or graft with review by radiologist, initial vessel, Ultrasound of both sides of head and neck blood flow, Ultrasound of leg arteries or artery grafts, Ultrasound of one leg arteries or artery grafts, Ultrasound study of arm and leg arteries, Ultrasound study of arm or leg veins with compression and maneuvers, Ultrasound study of one arm or leg veins with compression and maneuvers and Use of a drug to induce depression of consciousness by physician performing a procedure (5 years or older), initial 15 minutes.
The practitioner is affiliated to the following hospital(s): PROVIDENCE ST VINCENT MEDICAL CENTER. Hospital affiliations are identified through self-reporting data and service claims based on the place of service.
This NPI record was last updated on October 27, 2005. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
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