Active NPI
Nitza Quiles Soo, MD
- Pediatrics Physician
- Portland, OR
National Provider Identifier
1699814830
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- MD 12560
- Practice address
- 9555 SW Barnes Rd
#270
Portland, OR 97225 - Phone
- (503) 297-1025
- Fax
- (503) 297-1043
- NPI assigned
- Feb 5, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | MD 12560 | OR | Primary |
Addresses
Primary practice location
9555 SW Barnes Rd
#270
Portland, OR 97225
Mailing address
9555 SW Barnes Rd
#270
Portland, OR 97225
Phone (503) 297-1025
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| E87104 | Other | OR | PHP |
| 021993010 | Other | OR | BLUE CROSS |
| 135230 | Medicaid | OR | |
| 931129829A009 | Other | OR | TRICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD 12560 | OR | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Westside Pediatric Clinic PC | Pediatrics | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pediatrics Physician
- Portland, OR
- NPI 1093929226
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170633600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1330300800000",
"number": "1699814830",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9555 SW BARNES RD",
"address_2": "#270",
"city": "PORTLAND",
"state": "OR",
"postal_code": "97225",
"telephone_number": "503-297-1025",
"fax_number": "503-297-1043"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9555 SW BARNES RD",
"address_2": "#270",
"city": "PORTLAND",
"state": "OR",
"postal_code": "97225",
"telephone_number": "503-297-1025",
"fax_number": "503-297-1043"
}
],
"practiceLocations": [],
"basic": {
"last_name": "QUILES SOO",
"first_name": "NITZA",
"name_prefix": "Mrs.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-05",
"last_updated": "2012-02-27",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "OR",
"license": "MD 12560",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHP",
"identifier": "E87104",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "021993010",
"state": "OR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "135230",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "931129829A009",
"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 Feb 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.