NPIMap

Organization Active NPI

Centennial Pediatrics of Spokane, PLLC

  • Pediatrics Physician
  • Spokane, WA
National Provider Identifier
1346964806
Registry record updated Jul 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
CENTENNIAL PEDIATRICS OF SPOKANE, PLLC
Practice address
3010 S Southeast Blvd Ste a
Spokane, WA 99223-3540
Phone
(509) 352-3777
Fax
(509) 343-3717
NPI assigned
Sep 28, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2023

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

Authorized official

Name
Dr. Jennifer Kalisvaart, MDNPI 1073666137
Title
Owner
Phone
(562) 277-0834

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Child & Adolescent PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC2200X
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

3010 S Southeast Blvd Ste a
Spokane, WA 99223-3540

Mailing address

3010 S Southeast Blvd Ste a
Spokane, WA 99223-3540
Phone (509) 352-3777

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
50D2272515Centennial Pediatrics of Spokane3010 S Southeast Blvd Ste a, Spokane, WA 99223Certificate of waiverApr 4, 2028

National Provider Directory

National Provider Directory

Locations

3010 S Southeast Blvd
Ste A
Spokane, WA 99223
Phone (509) 625-3600

Practitioners & affiliated clinicians

Practitioners 5

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": "1664323200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689897600000",
    "number": "1346964806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3010 S SOUTHEAST BLVD STE A",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992233540",
            "telephone_number": "509-352-3777",
            "fax_number": "509-343-3717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3010 S SOUTHEAST BLVD STE A",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992233540",
            "telephone_number": "509-352-3777",
            "fax_number": "509-343-3717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTENNIAL PEDIATRICS OF SPOKANE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-28",
        "last_updated": "2023-07-21",
        "certification_date": "2023-07-21",
        "status": "A",
        "authorized_official_last_name": "KALISVAART",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "562-277-0834",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Spokane, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2023; 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.