Organization Active NPI

Rainbow Valley Pediatrics

  • Rural Health Clinic/Center
  • Silverton, OR
National Provider Identifier
1558054916
Registry record updated Apr 2, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
RAINBOW VALLEY PEDIATRICS
Practice address
605 Welch Street
Silverton, OR 97381
Phone
(503) 782-1975
Fax
(503) 343-6232
NPI assigned
May 31, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2026

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

Authorized official

Name
Alan Evert Edwards, MDNPI 1124003157
Title
Administrator
Phone
(724) 312-1931

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

605 Welch Street
Silverton, OR 97381

Mailing address

3780 Victor Point Rd NE
Silverton, OR 97381-9580
Phone (503) 400-0454

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20251113003060 OR Part A Provider - Rural Health Clinic 5597256909 Practice locations: Silverton, OR

Rural health clinic certification: CCN 383924

Legal name
RAINBOW VALLEY PEDIATRICS
Doing business as
RAINBOW VALLEY PEDIATRICS
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 25, 2026
Last certification
Feb 25, 2026
Ownership / control type
1B
Organization structure
LLCProprietary
Enrollment address
605 Welch St
Silverton, OR 97381-1946

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
38D2287424Rainbow Valley Pediatrics605 Welch Street, Silverton, OR 97381Certificate of waiverAug 13, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Monique Vaquera Individual W-2 Managing EmployeeOffice Manager Aug 14, 2023
Alan E Edwards Individual W-2 Managing EmployeeMD; Jun 2, 2025
Douglas S Hamblin Individual 5% Or Greater Direct Ownership InterestOwner Apr 10, 2023 100%

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 4

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": "1685491200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1775088000000",
    "number": "1558054916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3780 VICTOR POINT RD NE",
            "city": "SILVERTON",
            "state": "OR",
            "postal_code": "973819580",
            "telephone_number": "503-400-0454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "605 WELCH STREET",
            "city": "SILVERTON",
            "state": "OR",
            "postal_code": "97381",
            "telephone_number": "503-782-1975",
            "fax_number": "503-343-6232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RAINBOW VALLEY PEDIATRICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-31",
        "last_updated": "2026-04-02",
        "certification_date": "2026-04-02",
        "status": "A",
        "authorized_official_last_name": "EDWARDS",
        "authorized_official_first_name": "ALAN",
        "authorized_official_middle_name": "EVERT",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "724-312-1931",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Silverton, OR

Sources for this page

Verify at the official NPI Registry.