Individual provider Active NPI

Emily Nebzydoski, MD

  • Pediatrics Physician
  • Salem, OR
National Provider Identifier
1386987873
Registry record updated Jul 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
MD458096 Issued in PA
Practice address
435 Lancaster Dr NE
Salem, OR 97301-4729
Phone
(503) 585-6388
NPI assigned
Apr 3, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X MD458096 PA Primary

Addresses

Primary practice location

435 Lancaster Dr NE
Salem, OR 97301-4729

Mailing address

435 Lancaster Dr NE
Salem, OR 97301-4729
Phone (503) 585-6388

Other identifiers 1

IdentifierTypeStateIssuer
103131045MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, WA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20230921003070 OR Practitioner - Pediatric Medicine 7315233673 Reassigns benefits to 2 organizations
I20231024003114 WA Practitioner - Pediatric Medicine 7315233673 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Kaiser Foundation Health Plan of the Northwest Pediatrics Current Accepting new patients
Kaiser Foundation Health Plan of the Northwest Pediatrics CurrentSince Sep 12, 2023 Accepting new patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Sep 11, 2023 Accepting new patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Sep 11, 2023 Accepting new patients
Willamette Family Medical Center Inc CurrentSince Apr 28, 2025 Accepting new patients
Scranton Quincy Clinic Company LLC Past Accepting new patients
Pediatric Associates of Kingston, LLC Pediatrics PastSince Oct 1, 2020 Accepting new patients

Locations

10100 SE Sunnyside Rd
Clackamas, OR 97015
Phone (503) 571-2946

7201 N Interstate Ave
Portland, OR 97217
Phone (503) 240-4051

2400 Lancaster Dr NE
Salem, OR 97305
Phone (503) 361-5400

435 Lancaster Dr NE
Salem, OR 97301
Phone (503) 585-6388

1230 7th Ave
Longview, WA 98632
Phone (360) 575-4801

7101 NE 137th Ave
Vancouver, WA 98682
Phone (360) 418-6000

Interoperability endpoints

  • Direct secure messaging: emily.nebzydoski.p1@direct.wfamilymed.nextgenshare.com

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1364947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751414400000",
    "number": "1386987873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "435 LANCASTER DR NE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973014729",
            "telephone_number": "503-585-6388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "435 LANCASTER DR NE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973014729",
            "telephone_number": "503-585-6388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NEBZYDOSKI",
        "first_name": "EMILY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-04-03",
        "last_updated": "2025-07-02",
        "certification_date": "2025-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "PA",
            "license": "MD458096",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103131045",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, OR

Sources for this page

Verify at the official NPI Registry.