Portland Peritoneal Center, Inc.

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

License

394020 Issued in OR

Legal business name

PORTLAND PERITONEAL CENTER, INC.

Doing business as

Portland Dialysis Center

Practice address

10595 SE Stark St
Portland, OR 97216-2747

Phone

(503) 252-0019

Fax

(503) 252-0068

NPI assigned

Feb 2, 2006

Last updated

Aug 22, 2020By 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

Mr. Jerry Green

Title

Secretary

Phone

(562) 495-8075

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• PORTLAND DIALYSIS CENTER Doing business as

Locations

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

{
    "created_epoch": "1138838400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1437121704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 WORLD TRADE CTR",
            "address_2": "2500",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908310002",
            "telephone_number": "562-495-8075",
            "fax_number": "562-495-8076"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10595 SE STARK ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972162747",
            "telephone_number": "503-252-0019",
            "fax_number": "503-252-0068"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTLAND PERITONEAL CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "JERRY",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "562-495-8075",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "OR",
            "license": "394020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "121231",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PORTLAND DIALYSIS CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Portland Otologic Clinic PC (John M Epley MD)
• Portland Pain Medicine LLC
• Portland Pediatric Acupuncture
• Portland Pediatric Nutrition
• Portland Pediatric Psychology, LLC
• Portland Physical Therapy
• Portland Plastic Surgery Group, LLC
• Portland Preventive Cardiology LLC
• Portland Pro Health Therapies, PC
• Portland Professional Pharmacy, LLC (Portland Professional Pharmacy)

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Portland, OR
• Providers in Portland, OR by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.