PEDIATRIC ENDOCRINOLOGY OF PORTLAND, P.C. (NPI# 1639383466) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639383466 |
| Entity Type | Organization |
| Organization Name | PEDIATRIC ENDOCRINOLOGY OF PORTLAND, P.C. |
| Practice Address |
9155 Sw Barnes Rd Suite 931 Portland OR 97225-6625 |
| Practice Telephone | 5032063636 |
| Practice Fax Number | 5032063635 |
| Mailing Telephone | 5032063636 |
| Mailing Fax Number | 5032063635 |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. DALE MICHAEL WILLIS (PRESIDENT) |
| Authorized Official Telephone | 5032063636 |
| Authorized Official Credential | MD, PHD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080P0205X |
Pediatrics Specialization: Pediatric Endocrinology |
MD22738 | OR | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 287841 | 05 |
| Street Address |
9155 SW BARNES RD SUITE 931 |
| City | PORTLAND |
| State | OR |
| Zip Code | 97225-6625 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487657052 | Nancy Lynn Spencer | Nurse Practitioner | 9155 Sw Barnes Rd, Ste 740, Portland, OR 97225-6634 | 2005-05-27 |
| 1366918518 | Emily Secter | Occupational Therapist | 9155 Sw Barnes Rd, Portland, OR 97225 | 2018-10-15 |
| 1154806479 | Nicole Kuhl | Occupational Therapist | 9155 Sw Barnes Rd, Portland, OR 97225-6625 | 2018-10-02 |
| 1497267199 | Kolten William Paryzek | Physician Assistant | 9155 Sw Barnes Rd, Portland, OR 97225-6625 | 2017-11-02 |
| 1275077463 | Carolyn Durfee | Speech-Language Pathologist | 9155 Sw Barnes Rd, East Pavilion, Portland, OR 97225-6625 | 2016-12-07 |
| 1013466549 | Kimberly Grady | Physician Assistant | 9155 Sw Barnes Rd, Suite 321, Portland, OR 97225-6625 | 2016-09-26 |
| 1811443054 | Christie Veenkamp | Speech-Language Pathologist | 9155 Sw Barnes Rd, East Pavilion - PCdi (prov Children's Devel. Institute), Portland, OR 97225-6625 | 2016-08-28 |
| 1063967628 | Suzanne Mckenzie | Speech-Language Pathologist | 9155 Sw Barnes Rd, Portland, OR 97225-6625 | 2016-08-23 |
| 1720533516 | Amanda Margolin | Dietitian, Registered | 9155 Sw Barnes Rd, Suite 161, Portland, OR 97225-6625 | 2016-08-22 |
| 1053865592 | Ashleigh B Connell | Speech-Language Pathologist | 9155 Sw Barnes Rd, Children's Development Institute, East Pavilion, Portland, OR 97225-6625 | 2016-08-13 |
| 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 | 2080P0205X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Pediatric Endocrinology |
| A pediatrician who provides expert care to infants, children and adolescents who have diseases that result from an abnormality in the endocrine glands (glands which secrete hormones). These diseases include diabetes mellitus, growth failure, unusual size for age, early or late pubertal development, birth defects, the genital region and disorders of the thyroid, the adrenal and pituitary glands. |
| 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/certification - 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 |
|---|---|---|---|---|
| 1457759318 | Providence Health & Services - Oregon | Pediatrics | 9427 Sw Barnes Rd, Ste 395, Portland, OR 97225-6652 | 2014-12-09 |
| 1538396098 | Jonathan M Swartz | Pediatrics | 887 Congress St, Portland, ME 04102-3100 | 2009-06-11 |
| 1730383431 | Kara Jeanne Connelly | Pediatrics | 3181 Sw Sam Jackson Park Rd, Portland, OR 97239-3011 | 2007-06-14 |
| 1578571006 | Daniel L. Marks | Pediatrics | 3181 Sw Sam Jackson Park Rd, Portland, OR 97239-3011 | 2006-08-03 |
| 1003821505 | Bruce Alan Boston | Pediatrics | 3181 Sw Sam Jackson Park Rd, Portland, OR 97239-3011 | 2006-07-31 |
| 1639184138 | Stephen Henry Lafranchi | Pediatrics | 3181 Sw Sam Jackson Park Rd, Portland, OR 97239-3011 | 2006-07-31 |
| 1366457863 | Kathryn Anne Woods | Pediatrics | 3181 Sw Sam Jackson Park Rd, Portland, OR 97239-3011 | 2006-07-31 |
| 1649291576 | Lisa Driscoll Madison | Pediatrics | 3181 Sw Sam Jackson Park Rd, Portland, OR 97239-3011 | 2006-07-23 |
| 1306801386 | Lindsey E. Nicol | Pediatrics | 707 Sw Gaines St, Portland, OR 97239-2901 | 2006-04-20 |
| 1558322453 | David Brian Snyder | Pediatrics | 501 N Graham St, Suite 375, Portland, OR 97227-1654 | 2006-03-30 |
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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.