Active NPI
Northwest Renal Clinic, Inc.
- Nephrology Physician
- Portland, OR
National Provider Identifier
1780865642
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nephrology Physician
- Legal business name
- NORTHWEST RENAL CLINIC, INC.
- Practice address
- 9155 SW Barnes Rd Ste 402
Portland, OR 97225-6631 - Phone
- (503) 292-7704
- Fax
- (503) 292-7046
- NPI assigned
- Nov 20, 2007
- Last updated
- Jul 12, 2023
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Clayton M Smiley, MD
- Title
- MD
- Phone
- (503) 229-7976
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Nephrology Physician | 207RN0300X | NU | Primary |
Addresses
Primary practice location
9155 SW Barnes Rd Ste 402
Portland, OR 97225-6631
Mailing address
1130 NW 22ND Avenue
Suite 640
Portland, OR 97210
Phone (503) 229-7976
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 119297 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040429000295 | OR | Part B Supplier - Clinic/Group Practice | 8628065836 |
Receives reassigned benefits from 38 practitioners 9 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Portland, OR; Tualatin, OR; Salem, OR; McMinnville, OR; Hillsboro, OR; Clackamas, OR |
Other NPIs on the same Medicare enrollment 9
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider Directory- Tax ID family
- Northwest Renal CL Inc
Other organizations with this tax ID 8
Organizations that report the same tax identification number in the National Provider Directory.
-
dba Northwest Dialysis Access Center
- Ambulatory Surgical Clinic/Center
- Portland, OR
- NPI 1164946984
-
- Nephrology Physician
- McMinnville, OR
- NPI 1346081213
-
- Nephrology Physician
- Salem, OR
- NPI 1396378717
-
- Nephrology Physician
- Tualatin, OR
- NPI 1679752273
-
- Nephrology Physician
- Clackamas, OR
- NPI 1689117087
-
- Nephrology Physician
- Hillsboro, OR
- NPI 1750748901
-
- Nephrology Physician
- Portland, OR
- NPI 1861700130
Practitioners & affiliated clinicians
Practitioners 3
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.
-
- Nephrology Physician
- Portland, OR
- NPI 1679544431
-
- Nephrology Physician
- Portland, OR
- NPI 1568440584
-
- Nurse Practitioner
- Portland, OR
- NPI 1730748732
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1195516800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1689120000000",
"number": "1780865642",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1130 NW 22ND AVENUE",
"address_2": "SUITE 640",
"city": "PORTLAND",
"state": "OR",
"postal_code": "97210",
"telephone_number": "503-229-7976",
"fax_number": "503-274-4867"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9155 SW BARNES RD STE 402",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972256631",
"telephone_number": "503-292-7704",
"fax_number": "503-292-7046"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "NORTHWEST RENAL CLINIC, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2007-11-20",
"last_updated": "2023-07-12",
"certification_date": "2023-07-12",
"status": "A",
"authorized_official_last_name": "SMILEY",
"authorized_official_first_name": "CLAYTON",
"authorized_official_middle_name": "M",
"authorized_official_title_or_position": "MD",
"authorized_official_telephone_number": "503-229-7976",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207RN0300X",
"taxonomy_group": "",
"desc": "Internal Medicine, Nephrology",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "119297",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
- Northwest Regenerative Orthopedics
- Northwest Rehab Alliance (Nwra)
- Northwest Renal Clinic, Inc. (Northwest Dialysis Access Center)
- Northwest Renal Clinic, Inc.
- Northwest Renal Clinic, Inc.
- Northwest Renal Clinic, Inc.
- Northwest Renal Clinic, Inc.
- Northwest Rheumatology Associates, PC
- Northwest Spine Surgery LLC
- Northwest Surgical Specialists PC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2023; 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.