NPIMap

Organization Active NPI

Woodburn Pediatric Clinic LLP

  • Pediatrics Physician
  • Woodburn, OR
National Provider Identifier
1790969624
Registry record updated Oct 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
MD08572 Issued in OR
Legal business name
WOODBURN PEDIATRIC CLINIC LLP
Practice address
2050 Progress Way
Woodburn, OR 97071-9764
Phone
(503) 981-5348
Fax
(503) 981-0423
NPI assigned
Dec 27, 2007
Last updated
Oct 3, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2023

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

Authorized official

Name
Ms. Debra Elaine Bartel
Title
Practice Administrator
Phone
(503) 981-1236

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X MD08572 OR Primary

Addresses

Primary practice location

2050 Progress Way
Woodburn, OR 97071-9764

Mailing address

2050 Progress Way
Woodburn, OR 97071-9764
Phone (503) 981-5348

Other identifiers 1

IdentifierTypeStateIssuer
182287MedicaidOR

National Provider Directory

National Provider Directory

Locations

2050 Progress Way
Woodburn, OR 97071
Phone (503) 981-5348

Practitioners & affiliated clinicians

Practitioners 16

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 16

NPI Registry JSON

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

{
    "created_epoch": "1198713600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696291200000",
    "number": "1790969624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2050 PROGRESS WAY",
            "city": "WOODBURN",
            "state": "OR",
            "postal_code": "970719764",
            "telephone_number": "503-981-5348",
            "fax_number": "503-981-0423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2050 PROGRESS WAY",
            "city": "WOODBURN",
            "state": "OR",
            "postal_code": "970719764",
            "telephone_number": "503-981-5348",
            "fax_number": "503-981-0423"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOODBURN PEDIATRIC CLINIC LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-27",
        "last_updated": "2023-10-03",
        "certification_date": "2023-10-03",
        "status": "A",
        "authorized_official_last_name": "BARTEL",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "ELAINE",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "503-981-1236",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OR",
            "license": "MD08572",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "182287",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodburn, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2023; 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.