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DSH380060AD Portland Adventist Medical Center dba Adventist Health Portland (Approved)
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Main Details
Name
Portland Adventist Medical Center dba Adventist Health Portland
Subdivision Name
ADVENTIST HEALTH PORTLAND - AH Women's Clinic - Clackamas
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH380060AD
Medicare Provider Number
380060
Outpatient Facility Provider Number
Additional Details
Current Program Status
Approved
Registration Date
4/14/2025
Participating Start Date
7/1/2025
Participating Approval Date
5/5/2025
Last Recertification Date
Contacts
Authorizing Official
Portland Adventist Medical Center dba Adventist Health Portland
Jason Panasuk, Finance Officer
(503) 251-6121
Primary Contact
Adventist Health Portland
Rochelle Ford, Clinical Coordinator
(503) 261-6505
Addresses
Street Address
10151 SE SUNNYSIDE RD
STE 100
CLACKAMAS, OR 97015-5705
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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