NPIMap

Organization Active NPI

Portland Pediatric Group, LLP

  • Pediatrics Physician
  • Rochester, NY
National Provider Identifier
1174745285
Registry record updated Aug 31, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
207792 Issued in NY
Legal business name
PORTLAND PEDIATRIC GROUP, LLP
Practice address
1700 Hudson Ave
Rochester, NY 14617-5104
Phone
(585) 342-5694
Fax
(585) 342-2345
NPI assigned
May 2, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2012

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

Authorized official

Name
Dr. Roderick G Davis, M.DNPI 1679557128
Title
President
Phone
(585) 342-5694

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X 207792 NY Primary

Addresses

Primary practice location

1700 Hudson Ave
Rochester, NY 14617-5104

Mailing address

1700 Hudson Ave
Rochester, NY 14617-5104
Phone (585) 342-5694

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
33D1104135Portland Pediatric Group LLP1700 Hudson Ave, Rochester, NY 14617Certificate of waiverAug 25, 2027

National Provider Directory

National Provider Directory

Locations

1700 Hudson Ave
Rochester, NY 14617
Phone (585) 342-5665

Practitioners & affiliated clinicians

Practitioners 7

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": "1178064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1346371200000",
    "number": "1174745285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 HUDSON AVE",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146175104",
            "telephone_number": "585-342-5694",
            "fax_number": "585-342-2345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 HUDSON AVE",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146175104",
            "telephone_number": "585-342-5694",
            "fax_number": "585-342-2345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTLAND PEDIATRIC GROUP, LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-02",
        "last_updated": "2012-08-31",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "RODERICK",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "585-342-5694",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "207792",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rochester, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2012; 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.