CHILDREN'S COMMUNITY CLINIC (NPI# 1841483252) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1841483252 |
| Entity Type | Organization |
| Organization Name | CHILDREN'S COMMUNITY CLINIC |
| Practice Address |
27 Ne Killingsworth St Portland OR 97211-2623 |
| Practice Telephone | 5032845239 |
| Practice Fax Number | 5032849162 |
| Mailing Telephone | 5032845239 |
| Mailing Fax Number | 5032849162 |
| Enumeration Date | 2007-08-20 |
| Last Update Date | 2013-02-22 |
| Authorized Official Name | MS. MARDICA HICKS (CEO/ADMINISTRATOR) |
| Authorized Official Telephone | 5032845239 |
| Authorized Official Credential | MBA |
| 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 | 500612895 | 05 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | CHILDREN'S COMMUNITY CLINIC | 2250 Lloyd Center, Portland, OR 97232 |
| Street Address |
27 NE KILLINGSWORTH ST |
| City | PORTLAND |
| State | OR |
| Zip Code | 97211-2623 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568482610 | Robert Henry Schwartz | Allergy & Immunology | 27 Ne Killingsworth St, Portland, OR 97211-2623 | 2006-07-20 |
| 1568692978 | Cecille Beyl | Pediatrics | 27 Ne Killingsworth St, Portland, OR 97211-2623 | 2009-07-20 |
| 1962589226 | Mark S. Lindau | Pediatrics | 27 Ne Killingsworth St, Portland, OR 97211-2623 | 2006-11-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386104586 | Rachel Joy Kendall | Counselor | 5257 Nw Martin Luther King Jr. Blvd, 202e, Portland, OR 97211 | 2019-03-22 |
| 1073014601 | Kelli Minton | Behavior Technician | 7035 Ne 9th Ave, Portland, OR 97211 | 2018-02-28 |
| 1083145726 | Warren H Baumann | Registered Nurse | 854 Ne Simpson St, Portland, OR 97211 | 2017-03-24 |
| 1407277411 | Regina Barnett | Case Manager/Care Coordinator | 509 Ne Alberta St., Portland, OR 97211 | 2013-12-17 |
| 1578905964 | Carmel Therese Irving | Social Worker | 5912 Ne 16th Ave, Portland, OR 97211 | 2013-07-25 |
| 1629310990 | Lisa Peacock | Counselor | 4433 Ne 35 Place, Portland, OR 97211 | 2013-03-25 |
| 1285907915 | Michele Karen Koder | Pharmacist | 3529 Ne Martin Luther King, Jr. Blvd., Portland, OR 97211 | 2012-02-10 |
| 1629368196 | Alexis Miranda Barker | Massage Therapist | 4929 Ne 30th Ave, Zen Space Healing, Portland, OR 97211 | 2011-04-18 |
| 1396041760 | Kara Ann Fuerst | Specialist | 3325 Ne Prescott, Portland, OR 97211 | 2011-02-02 |
| 1063746337 | Laura K Elvers | Pharmacist | 6116 Ne Mlk, Portland, OR 97211 | 2009-09-18 |
| Find all providers in zip 97211 | ||||
| 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 | ||||
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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.