NPIMap

Organization Active NPI

Northwest Renal Clinic, Inc.

  • Nephrology Physician
  • Salem, OR
National Provider Identifier
1396378717
Registry record updated Sep 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
NORTHWEST RENAL CLINIC, INC.
Practice address
925 Commercial St SE Ste 110
Salem, OR 97302-4172
Phone
(503) 967-6670
Fax
(503) 585-2185
NPI assigned
Feb 13, 2020
Last updated
Sep 25, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
NORTHWEST RENAL CLINIC, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 25, 2020

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

Authorized official

Name
Clayton Michael Smiley, MDNPI 1679544431
Title
President
Phone
(503) 229-7976

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X Primary

Addresses

Primary practice location

925 Commercial St SE Ste 110
Salem, OR 97302-4172

Mailing address

925 Commercial St SE Ste 110
Salem, OR 97302-4172
Phone (503) 967-6670

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040429000295 OR Part B Supplier - Clinic/Group Practice 8628065836 Receives reassigned benefits from 38 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Portland, OR; Tualatin, OR; Salem, OR; McMinnville, OR; Hillsboro, OR; Clackamas, OR

Other NPIs on the same Medicare enrollment 9

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

National Provider Directory

National Provider Directory
Tax ID family
Northwest Renal CL Inc9 organizations share this tax ID, including this one
Part of
Northwest Renal CL Inc

Other organizations with this tax ID 8

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

Locations

925 Commercial St SE
Ste 150
Salem, OR 97302
Phone (503) 304-4358

Practitioners & affiliated clinicians

Practitioners 3

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": "1581552000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600992000000",
    "number": "1396378717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "925 COMMERCIAL ST SE STE 110",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973024172",
            "telephone_number": "503-967-6670",
            "fax_number": "503-585-2185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "925 COMMERCIAL ST SE STE 110",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973024172",
            "telephone_number": "503-967-6670",
            "fax_number": "503-585-2185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST RENAL CLINIC, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTHWEST RENAL CLINIC, INC.",
        "enumeration_date": "2020-02-13",
        "last_updated": "2020-09-25",
        "certification_date": "2020-09-25",
        "status": "A",
        "authorized_official_last_name": "SMILEY",
        "authorized_official_first_name": "CLAYTON",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "503-229-7976",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 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.