Wilshire Surgery Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

WILSHIRE SURGERY CENTER, LLC

Practice address

9775 SW Wilshire St
Suite 250
Portland, OR 97225-5020

Phone

(503) 688-5187

Fax

(503) 688-5199

NPI assigned

Jun 17, 2010

Last updated

Oct 18, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Stephanie D Fatheree

Title

Revenue /Credentialing Specialist

Phone

(503) 688-5187

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Listed as

Wilshire Surgery Center LLCCCN 38C0001094

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 1

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.

• Kathleen Anne Waldorf, MD

  • Plastic Surgery Physician
  • Portland, OR
  • NPI 1902995194
  NPD (past)

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

{
    "created_epoch": "1276732800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666051200000",
    "number": "1417278011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9775 SW WILSHIRE ST",
            "address_2": "SUITE 250",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972255020",
            "telephone_number": "503-688-5187",
            "fax_number": "503-688-5199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9775 SW WILSHIRE ST",
            "address_2": "SUITE 250",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972255020",
            "telephone_number": "503-688-5187",
            "fax_number": "503-688-5199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILSHIRE SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-17",
        "last_updated": "2022-10-18",
        "certification_date": "2022-10-18",
        "status": "A",
        "authorized_official_last_name": "FATHEREE",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "REVENUE /CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "503-688-5187"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Trent Willson, LMT
• Samantha Wilmart
• Brenda L Wilmarth, L.C.S.W.
• Vincent P Wilmarth, RPH
• Susan Marie Wilmoth, L. AC.
• Jenna Wilson Crain, N.D.
• Wilson Family Services LLC
• Corrine Wilson-Baurick, LPC
• Kirstie Lauren Wilson-Panum, M.D.
• R. Nathaniel Wilson-Traisman

• Ambulatory Surgical Clinic/Center in Portland, OR
• Providers in Portland, OR by specialty
• Ambulatory Surgical Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.