Active NPI
Nicholas R Backowski, D.M.D.
- Dentist
- Portland, OR
National Provider Identifier
1457784555
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D9941
- Practice address
- 2038 Lloyd Ctr
Portland, OR 97232-1309 - Phone
- (503) 288-5361
- NPI assigned
- Aug 13, 2013
- Last updated
- Dec 28, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D9941 | OR | Primary |
Addresses
Primary practice location
2038 Lloyd Ctr
Portland, OR 97232-1309
Mailing address
36840 Industrial Way B
Sandy, OR 97055-9254
Phone (503) 668-1300
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160104000424 | OR | Order and Referring Only - Dentist | 7214239581 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D9941 | OR | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1376352000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1451260800000",
"number": "1457784555",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "36840 INDUSTRIAL WAY B",
"city": "SANDY",
"state": "OR",
"postal_code": "970559254",
"telephone_number": "503-668-1300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2038 LLOYD CTR",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972321309",
"telephone_number": "503-288-5361"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BACKOWSKI",
"first_name": "NICHOLAS",
"middle_name": "R",
"credential": "D.M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-08-13",
"last_updated": "2015-12-28",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OR",
"license": "D9941",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.