NPIMap

Organization Active NPI

Geriatric Psychiatry Associates Northwest, P.C.

  • Geriatric Psychiatry Physician
  • Portland, OR
National Provider Identifier
1760674071
Registry record updated Aug 10, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Psychiatry PhysicianTaxonomy code 2084P0805X
License
MD11891 Issued in OR
Legal business name
GERIATRIC PSYCHIATRY ASSOCIATES NORTHWEST, P.C.
Practice address
1231 NE MLK Jr Blvd
#611
Portland, OR 97232-2073
Phone
(503) 258-9714
Fax
(503) 254-4840
NPI assigned
Aug 10, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2007

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

Authorized official

Name
Dr. Kevin R Smith, M.D.NPI 1366450801
Title
President
Phone
(503) 258-9714

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
Geriatric Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0805X MD11891 OR Primary

Addresses

Primary practice location

1231 NE MLK Jr Blvd
#611
Portland, OR 97232-2073

Mailing address

1231 NE MLK Jr Blvd
#611
Portland, OR 97232-2073
Phone (503) 258-9714

National Provider Directory

National Provider Directory

Locations

477 Peace Portal Dr
Ste 107
Blaine, WA 98230

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1186704000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1186704000000",
    "number": "1760674071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1231 NE MLK JR BLVD",
            "address_2": "#611",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972322073",
            "telephone_number": "503-258-9714",
            "fax_number": "503-254-4840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1231 NE MLK JR BLVD",
            "address_2": "#611",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972322073",
            "telephone_number": "503-258-9714",
            "fax_number": "503-254-4840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GERIATRIC PSYCHIATRY ASSOCIATES NORTHWEST, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-10",
        "last_updated": "2007-08-10",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "503-258-9714",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084P0805X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Geriatric Psychiatry",
            "state": "OR",
            "license": "MD11891",
            "primary": true
        }
    ],
    "identifiers": [],
    "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 10, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.