NPIMap

Organization Active NPI

The Ida Karlin Pediatric Center

  • Pediatrics Physician
  • Puyallup, WA
National Provider Identifier
1366657918
Registry record updated Dec 23, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
MD00015660 Issued in WA
Legal business name
THE IDA KARLIN PEDIATRIC CENTER
Practice address
319 5TH St SW
Puyallup, WA 98371-5828
Phone
(253) 848-0351
Fax
(253) 841-1397
NPI assigned
May 14, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2015

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

Authorized official

Name
Ovidio Penalver, MDNPI 1457357964
Title
Corporate Officer, Provider
Phone
(253) 848-0351

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101Y00000X LH60394287 WA
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X PY60385056 WA
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X MD00015660 WA Primary
Pediatric Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0200X AP60312846 WA
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X AP60311598 WA

Addresses

Primary practice location

319 5TH St SW
Puyallup, WA 98371-5828

Mailing address

319 5TH St SW
Puyallup, WA 98371-5828
Phone (253) 848-0351

Other identifiers 1

IdentifierTypeStateIssuer
7110653MedicaidWA

National Provider Directory

National Provider Directory

Locations

319 5th St SW
Puyallup, WA 98371
Phone (253) 223-6367

319 5th St SW
#C
Puyallup, WA 98371
Phone (253) 848-0351

Practitioners & affiliated clinicians

Practitioners 7

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": "1179100800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1450828800000",
    "number": "1366657918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "319 5TH ST SW",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983715828",
            "telephone_number": "253-848-0351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "319 5TH ST SW",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983715828",
            "telephone_number": "253-848-0351",
            "fax_number": "253-841-1397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE IDA KARLIN PEDIATRIC CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-14",
        "last_updated": "2015-12-23",
        "status": "A",
        "authorized_official_last_name": "PENALVER",
        "authorized_official_first_name": "OVIDIO",
        "authorized_official_title_or_position": "CORPORATE OFFICER, PROVIDER",
        "authorized_official_telephone_number": "253-848-0351",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": "WA",
            "license": "LH60394287",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "WA",
            "license": "PY60385056",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "WA",
            "license": "MD00015660",
            "primary": true
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "WA",
            "license": "AP60312846",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WA",
            "license": "AP60311598",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7110653",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Puyallup, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2015; 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.