NPIMap

Organization Active NPI

Kaiser Foundation Health Plan of the Northwest

  • Clinic Pharmacy
  • Clackamas, OR
National Provider Identifier
1407893407
Registry record updated Jun 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic PharmacyTaxonomy code 3336C0002X
License
RP-0001088-CS Issued in OR
Legal business name
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST
Practice address
10100 SE Sunnyside Rd
Clackamas, OR 97015-8970
Phone
(866) 280-1228
Fax
(503) 571-2789
NPI assigned
May 31, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2021

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

Authorized official

Name
Alfred Lyman, PHARMD, BCPS
Title
Executive Director, Regional Pharma
Phone
(800) 813-2000

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic Pharmacy 3336C0002X RP-0001088-CS OR Primary
Managed Care Organization Pharmacy 3336M0003X

Addresses

Primary practice location

10100 SE Sunnyside Rd
Clackamas, OR 97015-8970

Mailing address

10100 SE Sunnyside Rd
Clackamas, OR 97015-8970
Phone (866) 280-1228

Other identifiers 3

IdentifierTypeStateIssuer
136692MedicaidOR
2078434OtherPK
6019368MedicaidWA

Other names 1

  • Kaiser Permanente Mt. Talbert Pharmacy Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/interconnect-prodnwm/wcf/epic.community.hie/xcpdrespondinggateways Health Information Exchange (HIE)

National Provider Directory

National Provider Directory
Tax ID family
Permananet Clinic150 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1149033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622505600000",
    "number": "1407893407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10100 SE SUNNYSIDE RD",
            "city": "CLACKAMAS",
            "state": "OR",
            "postal_code": "970158970",
            "telephone_number": "866-280-1228",
            "fax_number": "503-571-2789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10100 SE SUNNYSIDE RD",
            "city": "CLACKAMAS",
            "state": "OR",
            "postal_code": "970158970",
            "telephone_number": "866-280-1228",
            "fax_number": "503-571-2789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-31",
        "last_updated": "2021-06-01",
        "certification_date": "2021-06-01",
        "status": "A",
        "authorized_official_last_name": "LYMAN",
        "authorized_official_first_name": "ALFRED",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR, REGIONAL PHARMA",
        "authorized_official_telephone_number": "800-813-2000",
        "authorized_official_credential": "PHARMD, BCPS"
    },
    "taxonomies": [
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "OR",
            "license": "RP-0001088-CS",
            "primary": true
        },
        {
            "code": "3336M0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Managed Care Organization Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "136692",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2078434",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6019368",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/interconnect-prodnwm/wcf/epic.community.hie/xcpdrespondinggateways",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "10100 SE Sunnyside Rd",
            "city": "Clackamas",
            "state": "OR",
            "country_code": "US",
            "postal_code": "970158970",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Kaiser Permanente Mt. Talbert Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kaiser Permanente Mt. Talbert Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clackamas, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2021; 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.