Pediatric Specialists of Pendleton, LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

11027630 Issued in OR

Legal business name

PEDIATRIC SPECIALISTS OF PENDLETON, LLC

Practice address

1600 SE Court PL
Suite, L01
Pendleton, OR 97801-3281

Phone

(541) 276-0250

Fax

(541) 276-0253

NPI assigned

Dec 22, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Donald Clifford Guenther, MD

Title

Manager

Phone

(541) 276-0250

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Rural health clinic certification: CCN 383874

Legal name

PEDIATRIC SPECIALISTS OF PENDLETON, LLC

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Jul 8, 2009

Last certification

Jul 10, 2024

Ownership / control type

1B

Organization structure

LLCProprietary

Enrollment address

2461 SW Perkins Ave
Pendleton, OR 97801-4301

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Pediatric Specialists of Pendleton, LLC

  • Rural Health Clinic/Center
  • Pendleton, OR
  • NPI 1952630576

  O20090430000283

  Same enrollment

Interoperability endpoints

• FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.441.1209

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Sara Schweigert Rickman, MD

  • Pediatrics Physician
  • Pendleton, OR
  • NPI 1407837719

  5% Or Greater Direct Ownership Interest, Corporate Director, General Partnership Interest

  CMS ownership
• Rhonda Lynn Wyland, MD

  • Pediatrics Physician
  • Pendleton, OR
  • NPI 1518948819

  5% Or Greater Direct Ownership Interest, Corporate Director, General Partnership Interest

  CMS ownership

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Anita Ruffino Hancock, MD

  • Pediatrics Physician
  • Hermiston, OR
  • NPI 1487634408
  NPD (past)
• Lynn Marie Lieuallen, FNP

  • Nurse Practitioner
  • Pendleton, OR
  • NPI 1629069893
  NPD (past)
• Sara Schweigert Rickman, MD

  • Pediatrics Physician
  • Pendleton, OR
  • NPI 1407837719
  NPD (past)
• Rhonda Lynn Wyland, MD

  • Pediatrics Physician
  • Pendleton, OR
  • NPI 1518948819
  NPD (past)

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

{
    "created_epoch": "1166745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1258934400000",
    "number": "1689739310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 SE COURT PL",
            "address_2": "SUITE, L01",
            "city": "PENDLETON",
            "state": "OR",
            "postal_code": "978013281",
            "telephone_number": "541-276-0250",
            "fax_number": "541-276-0253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 SE COURT PL",
            "address_2": "SUITE, L01",
            "city": "PENDLETON",
            "state": "OR",
            "postal_code": "978013281",
            "telephone_number": "541-276-0250",
            "fax_number": "541-276-0253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC SPECIALISTS OF PENDLETON, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-22",
        "last_updated": "2009-11-23",
        "status": "A",
        "authorized_official_last_name": "GUENTHER",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "CLIFFORD",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "541-276-0250",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "OR",
            "license": "11027630",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "288044",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Paul Deutschlander LLC
• Michael Payne
• Elizabeth Anne Pearson, MSW
• Jessica Suzanne Pedersen, LMT
• Amber Lynn Pederson, CRNA
• Pediatric Specialists of Pendleton, LLC
• Tami Jo Pelles
• Pearla Diana Pena, CADC I
• Victoria Linn Pender
• Pendleton Acadmies

• Clinic/Center in Pendleton, OR
• Providers in Pendleton, OR by specialty
• Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.