NPIMap

Organization Active NPI

Radiology Specialists of the Northwest, PC

  • Diagnostic Radiology Physician
  • Portland, OR
National Provider Identifier
1699759498
Registry record updated Aug 16, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
RADIOLOGY SPECIALISTS OF THE NORTHWEST, PC
Practice address
545 NE 47TH Ave
Suite 215
Portland, OR 97213-2238
Phone
(503) 731-2900
NPI assigned
Dec 5, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2010

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

Authorized official

Name
Ronald Kizziar, MDNPI 1316924046
Title
President
Phone
(503) 731-2900

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
Diagnostic Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0202X Primary

Addresses

Primary practice location

545 NE 47TH Ave
Suite 215
Portland, OR 97213-2238

Mailing address

PO Box 4000-21
Portland, OR 97208
Phone (503) 731-2900

Other identifiers 3

IdentifierTypeStateIssuer
7130669MedicaidWA
840126000OtherORREGENCE BCBS
227689MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, AZ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040407000754 OR Part B Supplier - Clinic/Group Practice 6204829963 Receives reassigned benefits from 33 practitioners
Practice locations: Portland, OR; Oregon City, OR; Hood River, OR; Canby, OR; Gresham, OR; Clackamas, OR
O20221107001372 AZ Part B Supplier - Clinic/Group Practice 6204829963 Receives reassigned benefits from 1 practitioner
Practice locations: Gilbert, AZ

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

5050 NE Hoyt St
Ste 625
Portland, OR 97213
Phone (503) 731-2900

Practitioners & affiliated clinicians

Practitioners 58

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.

View all 58

NPI Registry JSON

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

{
    "created_epoch": "1133740800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1281916800000",
    "number": "1699759498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4000-21",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97208",
            "telephone_number": "503-731-2900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "545 NE 47TH AVE",
            "address_2": "SUITE 215",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972132238",
            "telephone_number": "503-731-2900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RADIOLOGY SPECIALISTS OF THE NORTHWEST, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-05",
        "last_updated": "2010-08-16",
        "status": "A",
        "authorized_official_last_name": "KIZZIAR",
        "authorized_official_first_name": "RONALD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "503-731-2900",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7130669",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BCBS",
            "identifier": "840126000",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "227689",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Aug 16, 2010; 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.