NPIMap

Organization Active NPI

Oregon Pediatrics-Beaverton, LLC

  • Pediatrics Physician
  • Beaverton, OR
National Provider Identifier
1649081258
Registry record updated Jan 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
OREGON PEDIATRICS-BEAVERTON, LLC
Practice address
15950 SW Millikan Way Ste 100
Beaverton, OR 97003-5170
Phone
(503) 659-1694
Fax
(503) 659-8984
NPI assigned
Jan 14, 2025
Last updated
Jan 14, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2025

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

Authorized official

Name
Ankur Shah, MD, PHDNPI 1548678402
Title
Medical Director
Phone
(503) 659-1694

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
Pediatrics Physician 208000000X Primary

Addresses

Primary practice location

15950 SW Millikan Way Ste 100
Beaverton, OR 97003-5170

Mailing address

8645 SE Sunnybrook Blvd Ste 200
Clackamas, OR 97015-6841
Phone (503) 659-1694

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
38D2317124Oregon Pediatrics-Beaverton, LLC15950 SW Millikan Wy, #100, Beaverton, OR 97003Certificate of waiverJan 16, 2027

National Provider Directory

National Provider Directory
Tax ID family
Oregon Pediatrics-Beaverton LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

15950 SW Millikan Way
#100
Beaverton, OR 97003

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1736812800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736812800000",
    "number": "1649081258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8645 SE SUNNYBROOK BLVD STE 200",
            "city": "CLACKAMAS",
            "state": "OR",
            "postal_code": "970156841",
            "telephone_number": "503-659-1694",
            "fax_number": "503-659-8984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15950 SW MILLIKAN WAY STE 100",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970035170",
            "telephone_number": "503-659-1694",
            "fax_number": "503-659-8984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OREGON PEDIATRICS-BEAVERTON, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-14",
        "last_updated": "2025-01-14",
        "certification_date": "2025-01-14",
        "status": "A",
        "authorized_official_last_name": "SHAH",
        "authorized_official_first_name": "ANKUR",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "503-659-1694",
        "authorized_official_credential": "MD, PHD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Beaverton, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.