NPIMap

Organization Active NPI

Kaiser Foundation Health Plan of the Northwest

  • General Practice Dentistry
  • Portland, OR
National Provider Identifier
1073065207
Registry record updated Jun 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST
Practice address
10102 NE Glisan St
Portland, OR 97220-4456
Phone
(800) 813-2000
Fax
(503) 286-6879
NPI assigned
Nov 4, 2016
Last updated
Jun 1, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
KAISER PERMANENTE DENTAL CARE PROGRAMAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 1, 2021

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

Authorized official

Name
Mr. Kenneth R Wright
Title
VP Dental Care Services
Phone
(503) 813-4660

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X NU Primary

Addresses

Primary practice location

10102 NE Glisan St
Portland, OR 97220-4456

Mailing address

500 NE Multnomah St
Portland, OR 97232-2023
Phone (800) 813-2000

Other names 1

  • Glisan Dental Office Other name

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/interconnect-prodnwm/wcf/epic.community.hie/xcpdrespondinggateways Health Information Exchange (HIE)

National Provider Directory

National Provider Directory
Tax ID family
Kaiser Permenente150 organizations share this tax ID, including this one
Part of
Kaiser Permenente

Organizations with this tax ID in the same state 21

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 21

Locations

10102 NE Glisan St
Portland, OR 97220
Phone (503) 257-5959

NPI Registry JSON

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

{
    "created_epoch": "1478217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622505600000",
    "number": "1073065207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 NE MULTNOMAH ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972322023",
            "telephone_number": "800-813-2000",
            "fax_number": "503-286-6879"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10102 NE GLISAN ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972204456",
            "telephone_number": "800-813-2000",
            "fax_number": "503-286-6879"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KAISER PERMANENTE DENTAL CARE PROGRAM",
        "enumeration_date": "2016-11-04",
        "last_updated": "2021-06-01",
        "certification_date": "2021-06-01",
        "status": "A",
        "authorized_official_last_name": "WRIGHT",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "VP DENTAL CARE SERVICES",
        "authorized_official_telephone_number": "503-813-4660",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/interconnect-prodnwm/wcf/epic.community.hie/xcpdrespondinggateways",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "10102 NE Glisan St",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972204456",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Glisan Dental Office",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Glisan Dental Office",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Jun 1, 2021; 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.