NPIMap

Organization Active NPI

NW Pediatrics Integrative Medicine LLC

  • Primary Care Clinic/Center
  • Portland, OR
National Provider Identifier
1033832589
Registry record updated Oct 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
NW PEDIATRICS INTEGRATIVE MEDICINE LLC
Doing business as
NW Pediatrics Integrative Medicine
Practice address
11790 SW Barnes Rd Ste 140
Portland, OR 97225-5938
Phone
(503) 643-2100
NPI assigned
Sep 20, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tanya Markle
Title
Practice Manager
Phone
(503) 616-5665

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

11790 SW Barnes Rd Ste 140
Portland, OR 97225-5938

Mailing address

11790 SW Barnes Rd Ste 140
Portland, OR 97225-5938
Phone (503) 643-2100

Other names 1

  • NW Pediatrics Integrative Medicine Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1663632000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697587200000",
    "number": "1033832589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11790 SW BARNES RD STE 140",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972255938",
            "telephone_number": "503-643-2100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11790 SW BARNES RD STE 140",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972255938",
            "telephone_number": "503-643-2100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NW PEDIATRICS INTEGRATIVE MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-20",
        "last_updated": "2023-10-18",
        "certification_date": "2023-10-18",
        "status": "A",
        "authorized_official_last_name": "MARKLE",
        "authorized_official_first_name": "TANYA",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "503-616-5665"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NW Pediatrics Integrative Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.