NPIMap

Organization Active NPI

NW Dermatology and Research Center, LLC

Doing business as NW Dermatology Institute

  • Dermatology Physician
  • Portland, OR
National Provider Identifier
1679852396
Registry record updated May 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
NW DERMATOLOGY AND RESEARCH CENTER, LLC
Doing business as
NW Dermatology Institute
Practice address
2525 NW Lovejoy St Ste 400
Portland, OR 97210-2865
Phone
(503) 223-1933
NPI assigned
Aug 11, 2011
Last updated
May 8, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 8, 2020

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

Authorized official

Name
Nisha Shah Desai, MDNPI 1265605984
Title
Owner
Phone
(503) 223-1933

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
Dermatology Physician 207N00000X NU Primary

Addresses

Primary practice location

2525 NW Lovejoy St Ste 400
Portland, OR 97210-2865

Mailing address

2525 NW Lovejoy St Ste 400
Portland, OR 97210-2865
Phone (503) 223-1933

Other names 1

  • NW Dermatology Institute Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address nidesai@directaddress.net Health Information Exchange (HIE)

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111021000365 OR Part B Supplier - Clinic/Group Practice 2466625256 Receives reassigned benefits from 10 practitioners
Practice locations: Portland, OR

National Provider Directory

National Provider Directory

Locations

2525 NW Lovejoy St
Ste 305
Portland, OR 97210
Phone (503) 223-1933

Interoperability endpoints

  • Direct secure messaging: nidesai@directaddress.net

Practitioners & affiliated clinicians

Practitioners 10

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": "1313020800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588896000000",
    "number": "1679852396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2525 NW LOVEJOY ST STE 400",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972102865",
            "telephone_number": "503-223-1933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2525 NW LOVEJOY ST STE 400",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972102865",
            "telephone_number": "503-223-1933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NW DERMATOLOGY AND RESEARCH CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-11",
        "last_updated": "2020-05-08",
        "certification_date": "2020-05-08",
        "status": "A",
        "authorized_official_last_name": "DESAI",
        "authorized_official_first_name": "NISHA",
        "authorized_official_middle_name": "SHAH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-223-1933",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "nidesai@directaddress.net",
            "affiliation": "N",
            "endpointDescription": "direct message",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "xml",
            "address_1": "2525 NW Lovejoy St Ste 400",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972102865",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "NW Dermatology Institute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.