Childrens Clinic PC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

CHILDRENS CLINIC PC

Practice address

19260 SW 65TH Ave
Ste 340
Tualatin, OR 97062-5701

Phone

(503) 691-9777

Fax

(503) 692-6736

NPI assigned

Jul 26, 2007

Organization subpart

No

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

Authorized official

Name

Kelsey Durham

Title

Health Plan Coordinator

Phone

(503) 535-6314

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Childrens Clinic PC

  • Pediatrics Physician
  • Newberg, OR
  • NPI 1558806406

  O20070823000982

  Same enrollment
• Childrens Clinic PC

  • Pediatrics Physician
  • Portland, OR
  • NPI 1649219411

  O20070823000982

  Same enrollment

Tax ID family

Children's Clinic PC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

• Childrens Clinic PC

  • Pediatrics Physician
  • Newberg, OR
  • NPI 1558806406
  NPD tax ID
• Childrens Clinic PC

  • Pediatrics Physician
  • Portland, OR
  • NPI 1649219411
  NPD tax ID

Locations

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

{
    "created_epoch": "1185408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588032000000",
    "number": "1316137235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9555 SW BARNES RD",
            "address_2": "STE 301",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972256663",
            "telephone_number": "503-297-3371",
            "fax_number": "503-297-7975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19260 SW 65TH AVE",
            "address_2": "STE 340",
            "city": "TUALATIN",
            "state": "OR",
            "postal_code": "970625701",
            "telephone_number": "503-691-9777",
            "fax_number": "503-692-6736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILDRENS CLINIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-26",
        "last_updated": "2020-04-28",
        "certification_date": "2020-04-28",
        "status": "A",
        "authorized_official_last_name": "DURHAM",
        "authorized_official_first_name": "KELSEY",
        "authorized_official_title_or_position": "HEALTH PLAN COORDINATOR",
        "authorized_official_telephone_number": "503-535-6314"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500730975",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stephen Lumin Chen, M.D.
• Clarice Audrey Cheng, MD
• Deborah Ann Cherachanko, D.C.
• Emilee Marie Chesterfield, PA-C
• Ryan Edwin Childers, M.D.
• Alexander C Ching, MD
• Chiro One Wellness Center of Tualatin LLC
• Casey Chow, MA
• Jessie Elsa Christensen, RN
• Marla Christensen, LPC

• Pediatrics Physician in Tualatin, OR
• Providers in Tualatin, OR by specialty
• Pediatrics Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.