Oregon Pediatrics- Meridian Park, LLC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

OREGON PEDIATRICS- MERIDIAN PARK, LLC

Practice address

19250 SW 65TH Ave Ste 100
Tualatin, OR 97062-7707

Phone

(503) 691-2519

Fax

(503) 659-8984

NPI assigned

Jun 21, 2006

Last updated

Jun 4, 2020By 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

Mrs. Rupa Kirit Shah, MDNPI 1568408292

Title

Owner / Medical Director

Phone

(503) 659-1694

Specialties & licenses 1

Addresses

Other identifiers 1

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

CLIA laboratory certificates

Locations

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.

• Rupa Kirit Shah, MD

  • Pediatrics Physician
  • Clackamas, OR
  • NPI 1568408292
  Authorized official Same address or phone
• Pooja Banginwar, DO

  • Pediatrics Physician
  • Clackamas, OR
  • NPI 1013571959
  NPD (past)
• Diane Michelle Brace, FNP-BC

  • Family Nurse Practitioner
  • Oregon City, OR
  • NPI 1598427296
  NPD (past)
• Kylie Clark, M.D.

  • Pediatrics Physician
  • Portland, OR
  • NPI 1861788101
  NPD (past)
• Holly P Jastak, RN, MSN, FNP

  • Family Nurse Practitioner
  • Portland, OR
  • NPI 1023541869
  NPD (past)

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

{
    "created_epoch": "1150848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591228800000",
    "number": "1659317386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19250 SW 65TH AVE STE 100",
            "city": "TUALATIN",
            "state": "OR",
            "postal_code": "970627707",
            "telephone_number": "503-691-2519",
            "fax_number": "503-659-8984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19250 SW 65TH AVE STE 100",
            "city": "TUALATIN",
            "state": "OR",
            "postal_code": "970627707",
            "telephone_number": "503-691-2519",
            "fax_number": "503-659-8984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OREGON PEDIATRICS- MERIDIAN PARK, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-21",
        "last_updated": "2020-06-04",
        "certification_date": "2020-06-04",
        "status": "A",
        "authorized_official_last_name": "SHAH",
        "authorized_official_first_name": "RUPA",
        "authorized_official_middle_name": "KIRIT",
        "authorized_official_title_or_position": "OWNER / MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "503-659-1694",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "022713",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Oregon Eye Specialists, PC (The Sight Shop)
• Oregon Eye Specialists, PC (The Sight Shop)
• Oregon Health Endocrinology
• Oregon Neurology PC
• Oregon Occupational Medicine
• Oregon Spine Care LLC (Oregon Spine Care)
• Emily Ortiz, PA-C
• Nathan Daniel Orvets, MD
• Kaycee Lynn Owens, MS CC SLP
• Gary Owings, RPH

• Pediatrics Physician in Tualatin, OR
• Providers in Tualatin, OR by specialty
• Pediatrics Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2020; 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.