NPIMap

Organization Active NPI

PDX Allergy LLC

  • Allergy & Immunology Physician
  • Clackamas, OR
National Provider Identifier
1447874367
Registry record updated Apr 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Allergy & Immunology PhysicianTaxonomy code 207K00000X
Legal business name
PDX ALLERGY LLC
Practice address
8740 SE Sunnybrook Blvd Ste 300
Clackamas, OR 97015-5737
Phone
(971) 358-5600
Fax
(971) 358-5601
NPI assigned
Jun 5, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2024

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

Authorized official

Name
Angie Merriam
Title
Practice Manager
Phone
(971) 358-5600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Allergy & Immunology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207K00000X Primary

Addresses

Primary practice location

8740 SE Sunnybrook Blvd Ste 300
Clackamas, OR 97015-5737

Mailing address

9200 SE 91St Ave Ste 220
Happy Valley, OR 97086-3756
Phone (971) 358-5600

Other practice location 1

2150 NE Division St Ste 202
Gresham, OR 97030-5859
Phone (971) 358-5800

Other identifiers 2

IdentifierTypeStateIssuer
1447874367MedicaidOR
500784605MedicaidOR

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201016002631 OR Part B Supplier - Clinic/Group Practice 8224458062 Receives reassigned benefits from 7 practitioners
Practice locations: Clackamas, OR; Gresham, OR; Portland, OR

National Provider Directory

National Provider Directory

Locations

8740 SE Sunnybrook Blvd
Ste 300
Clackamas, OR 97015
Phone (971) 220-2201

2150 NE Division St
Ste 202
Gresham, OR 97030
Phone (503) 667-4545

831 NW Council Dr
Ste 212
Gresham, OR 97030
Phone (503) 489-2850

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1591315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712534400000",
    "number": "1447874367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9200 SE 91ST AVE STE 220",
            "city": "HAPPY VALLEY",
            "state": "OR",
            "postal_code": "970863756",
            "telephone_number": "971-358-5600",
            "fax_number": "971-358-5601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8740 SE SUNNYBROOK BLVD STE 300",
            "city": "CLACKAMAS",
            "state": "OR",
            "postal_code": "970155737",
            "telephone_number": "971-358-5600",
            "fax_number": "971-358-5601"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2150 NE Division St Ste 202",
            "address_purpose": "LOCATION",
            "city": "Gresham",
            "state": "OR",
            "postal_code": "970305859",
            "country_code": "US",
            "telephone_number": "971-358-5800",
            "fax_number": "971-358-5801",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PDX ALLERGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-05",
        "last_updated": "2024-04-08",
        "certification_date": "2024-04-08",
        "status": "A",
        "authorized_official_last_name": "MERRIAM",
        "authorized_official_first_name": "ANGIE",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "971-358-5600"
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Allergy & Immunology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1447874367",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500784605",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Apr 8, 2024; 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.