NPIMap

Organization Active NPI

Pediatric Associates of the Northwest, PC

  • Pediatrics Physician
  • Tigard, OR
National Provider Identifier
1174488787
Registry record updated Dec 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
PEDIATRIC ASSOCIATES OF THE NORTHWEST, PC
Practice address
7150 SW Dartmouth St
Tigard, OR 97223-7614
Phone
(503) 968-3480
Fax
(503) 227-4589
NPI assigned
Dec 17, 2025
Last updated
Dec 17, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
PEDIATRIC ASSOCIATES OF THE NORTHWEST, PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 17, 2025

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

Authorized official

Name
Jill Ewanchuk
Title
Practice Administrator
Phone
(503) 227-0671

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

7150 SW Dartmouth St
Tigard, OR 97223-7614

Mailing address

7150 SW Dartmouth St
Tigard, OR 97223-7614
Phone (503) 968-3480

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
38D0622078Pediatric Associates of the Northwest7150 SW Dartmouth Street, Tigard, OR 97223Certificate of waiverJul 24, 2027

National Provider Directory

National Provider Directory
Tax ID family
Pediatric Associates of the Northwest PC4 organizations share this tax ID, including this one
Part of
Pediatric Associates of the Northwest PC

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

7150 SW Dartmouth St
Tigard, OR 97223
Phone (503) 968-3421

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1765929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1765929600000",
    "number": "1174488787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7150 SW DARTMOUTH ST",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972237614",
            "telephone_number": "503-968-3480",
            "fax_number": "503-227-4589"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7150 SW DARTMOUTH ST",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972237614",
            "telephone_number": "503-968-3480",
            "fax_number": "503-227-4589"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC ASSOCIATES OF THE NORTHWEST, PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PEDIATRIC ASSOCIATES OF THE NORTHWEST, PC",
        "enumeration_date": "2025-12-17",
        "last_updated": "2025-12-17",
        "certification_date": "2025-12-17",
        "status": "A",
        "authorized_official_last_name": "EWANCHUK",
        "authorized_official_first_name": "JILL",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "503-227-0671"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tigard, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.