PEDIATRIC INTENSIVE CARE TRAUMA ASSOCIATES PC (NPI# 1083863682) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083863682 |
| Entity Type | Organization |
| Organization Name | PEDIATRIC INTENSIVE CARE TRAUMA ASSOCIATES PC |
| Practice Address |
2801 N Gantenbein Ave Portland OR 97227-1623 |
| Mailing Address |
Po Box 821350 Vancouver WA 98682-0030 |
| Practice Telephone | 8666222455 |
| Mailing Telephone | 8666222455 |
| Mailing Fax Number | 3606660466 |
| Enumeration Date | 2008-09-18 |
| Last Update Date | 2008-09-18 |
| Authorized Official Name | MR. CHRISTOPHER PHILLIPS (BILLING MANAGER) |
| Authorized Official Telephone | 3606673047 |
| Authorized Official Credential | CPC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080P0203X |
Pediatrics Specialization: Pediatric Critical Care Medicine |
Allopathic & Osteopathic Physicians |
| Street Address |
2801 N GANTENBEIN AVE |
| City | PORTLAND |
| State | OR |
| Zip Code | 97227-1623 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124027198 | James P Mccord | Pediatrics | 2801 N Gantenbein Ave, Portland, OR 97227-1623 | 2005-07-20 |
| 1225639040 | Lina Rossetti-grulich | Nurse Practitioner | 2801 N Gantenbein Ave, Portland, OR 97227-1623 | 2020-11-06 |
| 1033722673 | Karen Bronson | Pharmacist | 2801 N Gantenbein Ave, Portland, OR 97227-1623 | 2020-08-24 |
| 1356969331 | Sandy Hammer | Pharmacist | 2801 N Gantenbein Ave, Portland, OR 97227-1623 | 2020-07-07 |
| 1225673999 | Odaisa Igwe | Pharmacist | 2801 N Gantenbein Ave, Portland, OR 97227-1623 | 2019-11-16 |
| 1952945578 | Julie Lorine Hoover | Pharmacist | 2801 N Gantenbein Ave, Portland, OR 97227-1623 | 2019-11-06 |
| 1285278648 | Kate Harrell Unterberger | Pharmacist | 2801 N Gantenbein Ave, Portland, OR 97227-1623 | 2019-10-29 |
| 1780227082 | Keegan Carly Fritzke | Pharmacist | 2801 N Gantenbein Ave, Portland, OR 97227-1623 | 2019-10-21 |
| 1578106860 | Corinne Frohlick | Pharmacist | 2801 N Gantenbein Ave, Portland, OR 97227-1623 | 2019-10-20 |
| 1386287662 | Aimee Breitfelder Reddy | Pharmacist | 2801 N Gantenbein Ave, Portland, OR 97227-1623 | 2019-10-19 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508466574 | Jessica Michelle Simonetti | Psychologist | Portland Psychotherapy Clinic, Research and Training Ce, 3700 N Williams Ave, Portland, OR 97227 | 2020-10-29 |
| 1447812268 | Maksim Yefimov | Physician Assistant | 2800 N Vancouver Ave Ste 130, Portland, OR 97227 | 2019-07-01 |
| 1851955975 | Erin Marie Staples | Student in an Organized Health Care Education/Training Program | 2800 N. Vancouver Ave;, Suite 230, Portland, OR 97227 | 2019-04-24 |
| 1922588508 | Melanie Grace Mix | Physician Assistant | 501 N Graham St Ste 420, Portland, OR 97227 | 2018-08-14 |
| 1730615071 | Mehran Giblin | Student in an Organized Health Care Education/Training Program | 2800 N. Vancouver Ave, Suite 230, Legacy Clinic Emanuel, Portland, OR 97227 | 2017-05-05 |
| 1730623687 | Christina Grace Belter | Optometrist | 300 N Graham St Ste 300, Portland, OR 97227 | 2016-12-12 |
| 1407300205 | Jenna Abernathy | Counselor | 3537 N Williams Ave, Portland, OR 97227 | 2016-08-09 |
| 1215390760 | Tanya Marie Woods | Massage Therapist | 3808 N. Williams Ave., Portland, OR 97227 | 2016-04-01 |
| 1033596853 | Eric Allen Martin | Counselor | 2054 N. Vancouver Ave, Portland, OR 97227 | 2015-04-30 |
| 1285040436 | Berk Neurosurgical LLC | Neurological Surgery | 501 N Graham St Ste 500, Portland, OR 97227 | 2014-07-09 |
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| Taxonomy Code | 2080P0203X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Pediatric Critical Care Medicine |
| A pediatrician expert in advanced life support for children from the term or near-term neonate to the adolescent. This competence extends to the critical care management of life-threatening organ system failure from any cause in both medical and surgical patients and to the support of vital physiological functions. This specialist may have administrative responsibilities for intensive care units and also facilitates patient care among other specialists. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition changed, source added] Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. ACGME Accredited Residency Program Requirements: 2 years of training with 3 years Pediatrics plus 1 year Pediatric Critical Care for certification for a total of 6 years. ABMS Approved Subspecialty Certificate (Pediatrics) |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093294654 | Elva Linda Pereida | Pediatrics | 107 Palisades, Portland, TX 78374-4144 | 2018-08-14 |
| 1699066647 | Michael Zubrow | Pediatrics | 22 Bramhall St, Portland, ME 04102 | 2011-04-26 |
| 1487953154 | Laura Amar-dolan | Pediatrics | 22 Bramhall St, Portland, ME 04102-3175 | 2011-03-21 |
| 1609179639 | Shinpei Shibata | Pediatrics | 707 Sw Gaines St, Mail Code: Cdrcp, Portland, OR 97239-2901 | 2010-12-14 |
| 1437303443 | Cydni Nicole Williams | Pediatrics | 3181 Sw Sam Jackson Park Rd, Portland, OR 97239-3011 | 2008-11-05 |
| 1891976098 | Kristine M Pleacher | Pediatrics | 22 Bramhall St, Portland, ME 04102 | 2007-11-16 |
| 1861607434 | Amit Mehta | Pediatrics | 707 Sw Gaines St, Cdrc-p, Portland, OR 97239-2901 | 2007-05-14 |
| 1972649283 | Carolyn F Shelak | Pediatrics | 2801 N Gantenbein Ave, Legacy Emanuel Children's Hospital, Portland, OR 97227-1623 | 2007-01-30 |
| 1780692210 | Miles Steven Ellenby | Pediatrics | 3181 Sw Sam Jackson Park Rd, Doernbecher Children's Hospital Pediatric Icu, Portland, OR 97239-3011 | 2006-08-03 |
| 1780699298 | Aileen Lanette Kirby | Pediatrics | 3181 Sw Sam Jackson Park Rd, Portland, OR 97239-3011 | 2006-07-31 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.