MEDICARE: CORNER HEALTH MEDICAL GROUP NORTHWEST, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207QA0505X	Adult Medicine Physician
2	207R00000X	Internal Medicine Physician
3	363LP2300X	Primary Care Nurse Practitioner
4	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1366388209
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORNER HEALTH MEDICAL GROUP NORTHWEST, P.C.

Provider Business Mailing Address
First Line	:	10260 SW GREENBURG RD FL 4
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97223-5500
Country	:	US
Telephone Number	:	425-243-3719
Fax Number	:

Provider Business Practice Location Address
First Line	:	10260 SW GREENBURG RD FL 4
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97223-5500
Country	:	US
Telephone Number	:	425-243-3719
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	ANNE GIFFORD
Credential	:
Telephone Number	:	425-243-3719

Provider Enumeration Date	:	04/24/2026
Last Update Date	:	04/24/2026

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