Ihome Dialysis LLC

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

License

1899501978 Issued in OR

Legal business name

IHOME DIALYSIS LLC

Practice address

12045 SE Pardee St
Portland, OR 97266-3220

Phone

(503) 519-2672

Fax

(503) 761-0320

NPI assigned

Jan 19, 2015

Organization subpart

No

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

Authorized official

Name

Robert M Asa Jr.

Title

VP/Ceo

Phone

(503) 519-2672

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1421625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529971200000",
    "number": "1073902722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12045 SE PARDEE ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972663220",
            "telephone_number": "503-519-2672",
            "fax_number": "503-761-0320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12045 SE PARDEE ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972663220",
            "telephone_number": "503-519-2672",
            "fax_number": "503-761-0320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IHOME DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-19",
        "last_updated": "2018-06-26",
        "status": "A",
        "authorized_official_last_name": "ASA",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "VP/CEO",
        "authorized_official_telephone_number": "503-519-2672",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "OR",
            "license": "1899501978",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Paul Iguidbashian, MD
• Valeriy Igumnov, RN
• Odaisa Igwe
• Melissa Rose Ihly
• Gretchen M Ihms
• Moses Sujad Ijaz, D.O.
• Brian Ken Ikeda, PHARM.D.
• Ileap
• Kolose Ili
• Seyedeh Faye Iliaifar, PHARM D.

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Portland, OR
• Providers in Portland, OR by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2018; 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.