WESTSIDE PEDIATRIC CLINIC PC (NPI# 1093929226) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093929226 |
| Entity Type | Organization |
| Organization Name | WESTSIDE PEDIATRIC CLINIC PC |
| Practice Address |
9555 Sw Barnes Rd Suite 270 Portland OR 97225 |
| Practice Telephone | 5032971025 |
| Practice Fax Number | 5032971043 |
| Mailing Telephone | 5032971025 |
| Mailing Fax Number | 5032971043 |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2008-04-11 |
| Authorized Official Name | MRS. CONNIE LYNN DISTEFANO (ADMINISTRATOR) |
| Authorized Official Telephone | 5032971025 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 150220 | 05 |
| Street Address |
9555 SW BARNES RD SUITE 270 |
| City | PORTLAND |
| State | OR |
| Zip Code | 97225 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922001023 | Jay Christopher Andersen | Internal Medicine | 9555 Sw Barnes Rd, Ste 150, Portland, OR 97225-6663 | 2005-05-23 |
| 1285025619 | Rebecca Clark | Genetic Counselor, MS | 9555 Sw Barnes Rd, Suite 150, Portland, OR 97225-6663 | 2015-02-06 |
| 1437551199 | Saffron's Specialized Medical, Inc | Durable Medical Equipment & Medical Supplies | 9555 Sw Barnes Rd, Suite 215, Portland, OR 97225-6663 | 2014-09-24 |
| 1710398623 | Saffron Gustafson | Specialist | 9555 Sw Barnes Rd, Suite 215, Portland, OR 97225-6663 | 2014-05-13 |
| 1336577386 | Erin Cope | Social Worker | 9555 Sw Barnes Rd, Suite 100, Portland, OR 97225-6663 | 2013-10-29 |
| 1104252097 | Sarah Elizabeth Bodian | Advanced Practice Midwife | 9555 Sw Barnes Rd, Suite 100, Portland, OR 97225-6663 | 2013-09-24 |
| 1679821672 | Sandra Sue Karp | Nurse Practitioner | 9555 Sw Barnes Rd, Suite 100, Portland, OR 97225-6663 | 2012-08-22 |
| 1396009254 | Molly F Weeber | Registered Nurse | 9555 Sw Barnes Rd, Suite 100, Portland, OR 97225-6663 | 2012-06-26 |
| 1851667323 | Michelle Lynnette Monnie | Obstetrics & Gynecology | 9555 Sw Barnes Rd, Suite 100, Portland, OR 97225-6663 | 2012-03-28 |
| 1053688036 | Sunset Surgical Centre LLC | Clinic/Center | 9555 Sw Barnes Rd, Suite 275, Portland, OR 97225-6663 | 2011-11-19 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508425034 | Gabrielle Gonzales | Behavior Technician | 1675 Sw Marlow Ave, Suite 200, Portland, OR 97225 | 2019-06-08 |
| 1558844555 | Tate Roseberry | Behavior Technician | 1675 Sw Marlow Avenue, Suite 200, Portland, OR 97225 | 2018-09-14 |
| 1982186300 | Dean Alan Hopkins | Registered Nurse | 11782 Sw Barnes Rd, Suite 300, Portland, OR 97225 | 2018-09-01 |
| 1316449168 | Surgery Center At St. Vincent, LLC | Clinic/Center | 9135 Sw Barnes Rd Ste 161, Portland, OR 97225 | 2018-03-07 |
| 1730606716 | Meghan Louise Lacy | Pediatrics | 11790 Sw Barnes Rd, Blg. A, Suite 140, Portland, OR 97225 | 2017-08-29 |
| 1841733433 | Tia Pugh | Occupational Therapist | 9155 S.w. Barnes Road, East Pavilion, Portland, OR 97225 | 2016-11-30 |
| 1295185585 | Stephanie Lynn Hart | Nurse Practitioner | 9155 Sw Barnes Rd Ste 240, Portland, OR 97225 | 2016-06-16 |
| 1962866244 | Bejian Shamloo | Chiropractor | 10200 Sw Eastridge St., Suite 235, Portland, OR 97225 | 2016-04-12 |
| 1992162630 | Robert Joseph Yoder | Psychologist | 9045 Barnes Rd, Portland, OR 97225 | 2016-01-26 |
| 1316303951 | Katie Herold | Chiropractor | 9315 Sw Morrison St, Portland, OR 97225 | 2016-01-12 |
| Find all providers in zip 97225 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730606716 | Meghan Louise Lacy | Pediatrics | 11790 Sw Barnes Rd, Blg. A, Suite 140, Portland, OR 97225 | 2017-08-29 |
| 1447663810 | Anh Linh Hoang | Pediatrics | 9243 Ne Glisan St, Portland, OR 97220-4533 | 2014-06-03 |
| 1255771671 | Steven Donald Mcgaughey | Pediatrics | Ohsu Doernbecher, 3181 Sw Sam Jackson Park Road, Portland, OR 97239-1002 | 2013-06-29 |
| 1508109539 | Ramya Mishra Jariwala | Pediatrics | 9155 Sw Barnes Rd Ste 840, Portland, OR 97225 | 2013-03-28 |
| 1801162789 | Gabriel Larson | Pediatrics | 700 S.w. Campus Drive, 7th Floor, Portland, OR 97239 | 2012-03-26 |
| 1376833616 | Ashley Holsen | Pediatrics | 10000 Se Main St Ste 30, Portland, OR 97216-2461 | 2011-04-07 |
| 1477852259 | Kelsey Linde Richardson | Pediatrics | 3181 Sw Sam Jackson Hall Rd, Portland, OR 97239 | 2011-03-20 |
| 1093038986 | Seth M Williams | Pediatrics | 2801 N. Gantenbein Legacy Emanuel Medical Center, Randall Children's Hospital, Portland, OR 97227 | 2010-03-05 |
| 1669600904 | Erica Empey Benthin | Pediatrics | 205 Nw 16th Ave Apt 7, Portland, OR 97209-2648 | 2009-06-25 |
| 1871720136 | Corey Adair Fish | Pediatrics | 6924 Ne Sandy Blvd, Portland, OR 97213-5256 | 2009-06-14 |
| Find all providers in PORTLAND | ||||
Please comment or provide details below to improve the information on WESTSIDE PEDIATRIC CLINIC PC.
| 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.