NPIMap

Organization Active NPI

Northwest Renal Clinic, Inc.

  • Nephrology Physician
  • Portland, OR
National Provider Identifier
1528036662
Registry record updated Sep 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
NORTHWEST RENAL CLINIC, INC.
Practice address
1130 NW 22ND Ave Ste 640
Portland, OR 97210-2993
Phone
(503) 229-7976
Fax
(503) 274-4867
NPI assigned
Mar 14, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2025

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

Authorized official

Name
Clayton M Smiley, MDNPI 1679544431
Title
MD
Phone
(503) 229-7976

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RN0300X Primary

Addresses

Primary practice location

1130 NW 22ND Ave Ste 640
Portland, OR 97210-2993

Mailing address

PO Box 3068
Portland, OR 97208-3068
Phone (503) 229-7976

Other practice location 1

633 Ponahawai St Ste 103
Hilo, HI 96720-7601
Phone (808) 481-2300

Other practice location 2

4473 Pahee St Ste L
Lihue, HI 96766-2037
Phone (808) 632-0200

Other practice location 3

105 Maui Lani Pkwy Ste 100
Wailuku, HI 96793-2443
Phone (808) 442-7777

Other practice location 4

10201 SE Main St Ste 27
Portland, OR 97216-2937
Phone (503) 256-0877

Other practice location 5

4224 NE Halsey St Ste 300
Portland, OR 97213-1568
Phone (503) 235-5509

Other practice location 6

730 SE Oak St Ste I
Hillsboro, OR 97123-4245
Phone (503) 430-0497

Other practice location 7

9155 SW Barnes Rd Ste 402
Portland, OR 97225-6631
Phone (503) 292-7704

Other practice location 8

12550 SE 93rd Ave Ste 250
Clackamas, OR 97015-6787
Phone (503) 654-1153

Other practice location 9

232 NE Norton Ln
McMinnville, OR 97128-8470
Phone (503) 434-1159

Other practice location 10

8050 SW Warm Springs St Ste 150
Tualatin, OR 97062-7422
Phone (503) 692-7971

Other practice location 11

925 Commercial St SE Ste 110
Salem, OR 97302-4173
Phone (503) 967-6670

Other identifiers 3

IdentifierTypeStateIssuer
1029926MedicaidWA
500400267MedicaidOR
800151MedicaidHI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, HI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040429000295 OR Part B Supplier - Clinic/Group Practice 8628065836 Receives reassigned benefits from 38 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Portland, OR; Tualatin, OR; Salem, OR; McMinnville, OR; Hillsboro, OR; Clackamas, OR
O20191211003109 HI Part B Supplier - Clinic/Group Practice 8628065836 Receives reassigned benefits from 17 practitioners
Practice locations: Hilo, HI; Lihue, HI; Wailuku, HI

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 9

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
38D0690386Northwest Renal Clinic1130 NW 22ND Ave Ste 640, Portland, OR 97210Provider-performed microscopyDec 30, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 37

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

View all 37

NPI Registry JSON

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

{
    "created_epoch": "1142294400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758758400000",
    "number": "1528036662",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3068",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083068",
            "telephone_number": "503-229-7976",
            "fax_number": "503-274-4867"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1130 NW 22ND AVE STE 640",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972102993",
            "telephone_number": "503-229-7976",
            "fax_number": "503-274-4867"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "633 Ponahawai St Ste 103",
            "address_purpose": "LOCATION",
            "city": "Hilo",
            "state": "HI",
            "postal_code": "967207601",
            "country_code": "US",
            "telephone_number": "808-481-2300",
            "fax_number": "808-481-2301",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4473 Pahee St Ste L",
            "address_purpose": "LOCATION",
            "city": "Lihue",
            "state": "HI",
            "postal_code": "967662037",
            "country_code": "US",
            "telephone_number": "808-632-0200",
            "fax_number": "808-632-0201",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "105 Maui Lani Pkwy Ste 100",
            "address_purpose": "LOCATION",
            "city": "Wailuku",
            "state": "HI",
            "postal_code": "967932443",
            "country_code": "US",
            "telephone_number": "808-442-7777",
            "fax_number": "808-442-7778",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10201 SE Main St Ste 27",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972162937",
            "country_code": "US",
            "telephone_number": "503-256-0877",
            "fax_number": "503-256-4188",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4224 NE Halsey St Ste 300",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972131568",
            "country_code": "US",
            "telephone_number": "503-235-5509",
            "fax_number": "503-235-5335",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "730 SE Oak St Ste I",
            "address_purpose": "LOCATION",
            "city": "Hillsboro",
            "state": "OR",
            "postal_code": "971234245",
            "country_code": "US",
            "telephone_number": "503-430-0497",
            "fax_number": "503-747-5985",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9155 SW Barnes Rd Ste 402",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972256631",
            "country_code": "US",
            "telephone_number": "503-292-7704",
            "fax_number": "503-292-7046",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "12550 SE 93rd Ave Ste 250",
            "address_purpose": "LOCATION",
            "city": "Clackamas",
            "state": "OR",
            "postal_code": "970156787",
            "country_code": "US",
            "telephone_number": "503-654-1153",
            "fax_number": "503-654-7693",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "232 NE Norton Ln",
            "address_purpose": "LOCATION",
            "city": "McMinnville",
            "state": "OR",
            "postal_code": "971288470",
            "country_code": "US",
            "telephone_number": "503-434-1159",
            "fax_number": "503-434-1190",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8050 SW Warm Springs St Ste 150",
            "address_purpose": "LOCATION",
            "city": "Tualatin",
            "state": "OR",
            "postal_code": "970627422",
            "country_code": "US",
            "telephone_number": "503-692-7971",
            "fax_number": "503-691-6837",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "925 Commercial St SE Ste 110",
            "address_purpose": "LOCATION",
            "city": "Salem",
            "state": "OR",
            "postal_code": "973024173",
            "country_code": "US",
            "telephone_number": "503-967-6670",
            "fax_number": "503-691-6837",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NORTHWEST RENAL CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-14",
        "last_updated": "2025-09-25",
        "certification_date": "2025-09-25",
        "status": "A",
        "authorized_official_last_name": "SMILEY",
        "authorized_official_first_name": "CLAYTON",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "503-229-7976",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1029926",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500400267",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "800151",
            "state": "HI"
        }
    ],
    "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 Sep 25, 2025; 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.