NPIMap

Organization Active NPI

Pediatric Associates of Gresham PC

  • Pediatrics Physician
  • Gresham, OR
National Provider Identifier
1568592913
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
0659871-9 Issued in OR
Legal business name
PEDIATRIC ASSOCIATES OF GRESHAM PC
Practice address
2150 NE Division St Ste 103
Gresham, OR 97030-5858
Phone
(503) 661-4200
Fax
(503) 666-0566
NPI assigned
Mar 6, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Norman T Eki, MD
Title
President
Phone
(503) 661-4200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X 0659871-9 OR Primary

Addresses

Primary practice location

2150 NE Division St Ste 103
Gresham, OR 97030-5858

Mailing address

2150 NE Division St Ste 103
Gresham, OR 97030-5858
Phone (503) 661-4200

Other identifiers 1

IdentifierTypeStateIssuer
0659871-9OtherORBUSINESS ID NUMBER

National Provider Directory

National Provider Directory

Locations

2150 NE Division St
Ste 103
Gresham, OR 97030
Phone (503) 661-4200

Practitioners & affiliated clinicians

Practitioners 6

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": "1173139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1568592913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2150 NE DIVISION ST STE 103",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970305858",
            "telephone_number": "503-661-4200",
            "fax_number": "503-666-0566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2150 NE DIVISION ST STE 103",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970305858",
            "telephone_number": "503-661-4200",
            "fax_number": "503-666-0566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC ASSOCIATES OF GRESHAM PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "EKI",
        "authorized_official_first_name": "NORMAN",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "503-661-4200",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "OR",
            "license": "0659871-9",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BUSINESS ID NUMBER",
            "identifier": "0659871-9",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gresham, OR

Sources for this page

  • 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.