Northwest Spine and Laser Surgery Center LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

NORTHWEST SPINE AND LASER SURGERY CENTER LLC

Practice address

8995 SW Miley Rd
Suite 204
Wilsonville, OR 97070-5484

Phone

(267) 760-4734

NPI assigned

Nov 5, 2012

Last updated

Nov 5, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Darrell C Brett, MD

Title

President

Phone

(503) 253-6886

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Listed as

Northwest Spine and Laser Surgery Center LLCCCN 38C0001105

Medicare certification status

ActiveFrom the Provider of Services file

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

CLIA laboratory certificates

Member of 3

Organizations this organization is a member of, according to the National Provider Directory.

• J Rafe Sales, MD PC

  • Specialist
  • Portland, OR
  • NPI 1972750669

  Member Of

  NPD member
• Joseph P Stapleton MD, PC

  dba Portland Pain Care

  • Pain Medicine (Anesthesiology) Physician
  • Portland, OR
  • NPI 1376728097

  Member Of

  NPD member
• Portland Neurosurgery PC

  • Neurological Surgery Physician
  • Portland, OR
  • NPI 1588869572

  Member Of

  NPD member

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jeffrey P Johnson, M.D.

  • Neurological Surgery Physician
  • Portland, OR
  • NPI 1457326647
  NPD (past)
• Jordi X Kellogg, MD

  • Neurological Surgery Physician
  • Portland, OR
  • NPI 1669415964
  NPD (past)

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

{
    "created_epoch": "1352073600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1352073600000",
    "number": "1578817078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8995 SW MILEY RD",
            "address_2": "SUITE 204",
            "city": "WILSONVILLE",
            "state": "OR",
            "postal_code": "970705484",
            "telephone_number": "267-760-4734"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8995 SW MILEY RD",
            "address_2": "SUITE 204",
            "city": "WILSONVILLE",
            "state": "OR",
            "postal_code": "970705484",
            "telephone_number": "267-760-4734"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST SPINE AND LASER SURGERY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-05",
        "last_updated": "2012-11-05",
        "status": "A",
        "authorized_official_last_name": "BRETT",
        "authorized_official_first_name": "DARRELL",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "503-253-6886",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• No Boundaries Sport and Spine LLC
• Arleen Norkitis, PT
• Solomon A Norris, ATC
• Northwest Extremity Specialists LLC (NES Wilsonville)
• Northwest HC Cascadia Village Or Operator NT-Hci LLC (Avamere at Cascadia Village)
• Michelle Ashley Nunley, PTA
• NW Integrative Primary Care
• Nwsa Inc
• Kelly O'Connell
• Taylor L Odom

• Ambulatory Surgical Clinic/Center in Wilsonville, OR
• Providers in Wilsonville, OR by specialty
• Ambulatory Surgical Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2012; 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.