WILLAMETTE FALLS PEDIATRIC GROUP (NPI# 1629103361) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629103361 |
| Entity Type | Organization |
| Organization Name | WILLAMETTE FALLS PEDIATRIC GROUP |
| Practice Address |
1510 Division St Suite 280 Oregon City OR 97045-1581 |
| Practice Telephone | 5039053400 |
| Practice Fax Number | 5039053399 |
| Mailing Telephone | 5039053400 |
| Mailing Fax Number | 5039053399 |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2008-06-16 |
| Authorized Official Name | CHRISTINA M GRUCELLA (PRESIDENT) |
| Authorized Official Telephone | 5039053400 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | MD16083 | OR | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | BLUE CROSS BLUE SHIELD | 820444000 | 01 |
| OR | 028484 | 05 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | WILLAMETTE FALLS PEDIATRIC GROUP, P.C. | 1510 Division Street, Suite 280, Oregon City, OR 97045 |
| Street Address |
1510 DIVISION ST SUITE 280 |
| City | OREGON CITY |
| State | OR |
| Zip Code | 97045-1581 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750387049 | Kevin Raymond Johnson I | Surgery | 1510 Division St, Ste 210, Oregon City, OR 97045-1599 | 2005-06-22 |
| 1558819235 | Heather Mirenda | Social Worker | 1510 Division St, 90, Oregon City, OR 97045-1581 | 2016-09-12 |
| 1538454665 | Providence Health & Services - Oregon | Internal Medicine | 1510 Division St, Suite 130, Oregon City, OR 97045-1572 | 2011-06-16 |
| 1346533585 | Providence Health & Services - Oregon | Clinic/Center | 1510 Division St, Suite 100, Oregon City, OR 97045-1572 | 2011-05-20 |
| 1144529306 | Jennifer Eileen Shepard | Pediatrics | 1510 Division St, Suite 280, Oregon City, OR 97045-1581 | 2011-03-26 |
| 1194057497 | Providence Health & Services - Oregon | Clinic/Center | 1510 Division St, Ste 170, Oregon City, OR 97045-1581 | 2010-02-11 |
| 1730411034 | Providence Health & Services - Oregon | Clinic/Center | 1510 Division St, Suite 210, Oregon City, OR 97045-1599 | 2010-02-11 |
| 1821320128 | Providence Health & Services - Oregon | Clinic/Center | 1510 Division St, Ste 170, Oregon City, OR 97045-2551 | 2010-02-11 |
| 1891026647 | Providence Health & Services - Oregon | Clinic/Center | 1510 Division St, Suite 200, Oregon City, OR 97045-1599 | 2010-01-19 |
| 1942454087 | Willamette Falls Hospital | Physical Medicine & Rehabilitation | 1510 Division St, Suite 170, Oregon City, OR 97045-1581 | 2008-11-14 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528625621 | Dylan Wile | Physical Therapist | 19721 Or 213, Oregon City, OR 97045 | 2019-05-23 |
| 1952871576 | April Saylor | Dental Hygienist | 15530 S. Morel Dr, Oregon City, OR 97045 | 2018-11-27 |
| 1598251688 | Sara Noelle Wetten | Dental Assistant | 1900 Mclouglin Blvd #68, Oregon City, OR 97045 | 2018-07-02 |
| 1649761941 | Carol Ann Cranfill | Specialist | 1001 Molalla Ave. Ste 206, Oregon City, OR 97045 | 2018-05-22 |
| 1790286029 | Kathleen Walker | Registered Nurse | 110 Beaverceek Rd., Oregon City, OR 97045 | 2018-02-22 |
| 1174032429 | Amanda Brannin | Dental Hygienist | 15018 Pebble Beach Dr, Oregon City, OR 97045 | 2017-09-28 |
| 1003332669 | Clackamas Medical Supplies | Durable Medical Equipment & Medical Supplies | 2050 Beavercreek Rd. Ste 101-385, Oregon, OR 97045 | 2017-08-16 |
| 1154870129 | Staci S Meador | Nurse Practitioner | 1508 Division St Ste 200, Oregon City, OR 97045 | 2016-10-01 |
| 1821541939 | Samuel R. Sabo | General Practice | 18171 Waldow Rd., Oregon City, OR 97045 | 2016-07-26 |
| 1619339967 | Carly Chambers | Physical Therapist | 1630 S Beavercreeak Rd, Suite A, Oregon City, OR 97045 | 2016-03-25 |
| Find all providers in zip 97045 | ||||
| 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 |
|---|---|---|---|---|
| 1114558368 | Oregon Pediatrics-oregon City, PC | Pediatrics | 1510 Division St Ste 80, Oregon City, OR 97045-1572 | 2020-01-27 |
| 1508130204 | Christine Guenzi | Pediatrics | Willamette Falls Pediatric Group 1510 Division St, Suite 280, Oregon City, OR 97045 | 2012-02-28 |
| 1366734808 | Kristine Yumi Uyesugi | Pediatrics | 14279 S Glen Oaks Rd, Oregon City, OR 97045-8008 | 2011-05-03 |
| 1417155391 | Scott Simner Spencer | Pediatrics | 1510 Division St., Ste. 280, Oregon City, OR 97045 | 2007-07-03 |
| 1750592499 | Lisa Ann Badon | Pediatrics | 1510 Division, Suite 280 Willamette Falls Pediatric Group., Oregon City, OR 97045 | 2007-05-24 |
| 1033203500 | Joanne Hay-ling Wong | Pediatrics | 1510 Division St., Suite 280, Oregon City, OR 97045 | 2006-10-02 |
| 1528073020 | Christina Marie Grucella | Pediatrics | 1510 Division St Ste 280, Oregon City, OR 97045-2550 | 2006-07-31 |
| 1518423086 | Magdalenne Corso, Md LLC | Pediatrics | 14279 S Glen Oaks Rd, Oregon City, OR 97045-8008 | 2019-02-20 |
| 1689179525 | Kristine Uyesugi, M.d., L.L.C. | Pediatrics | 14279 S Glen Oaks Rd, Oregon City, OR 97045-8008 | 2018-03-23 |
| 1790280634 | James Resk, M.d., P.C. | Pediatrics | 14279 S Glen Oaks Rd, Oregon City, OR 97045-8008 | 2018-03-23 |
| Find all providers in OREGON CITY | ||||
| City | OREGON CITY |
| Zip Code | 97045 |
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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.