Northwest Pediatric Kidney Specialists LLC

Primary specialty

Pediatric Nephrology PhysicianTaxonomy code 2080P0210X

License

MD12771 Issued in OR

Legal business name

NORTHWEST PEDIATRIC KIDNEY SPECIALISTS LLC

Practice address

1935 NW Norfolk CT
Portland, OR 97229-8448

Phone

(503) 297-3178

NPI assigned

May 31, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Randall Jenkins, MD

Title

Doctor

Phone

(503) 297-3178

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1180569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1337299200000",
    "number": "1801098108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1935 NW NORFOLK CT",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972298448",
            "telephone_number": "503-297-3178"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1935 NW NORFOLK CT",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972298448",
            "telephone_number": "503-297-3178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST PEDIATRIC KIDNEY SPECIALISTS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-31",
        "last_updated": "2012-05-18",
        "status": "A",
        "authorized_official_last_name": "JENKINS",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "503-297-3178",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2080P0210X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Pediatric Nephrology",
            "state": "OR",
            "license": "MD12771",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7077415",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "080767",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Northwest Neurological Specialists PC
• Northwest Newborn Specialists PC
• Northwest Optometric Associates Inc
• Northwest Pediatric Critical Care PC
• Northwest Pediatric Gastroenterology, LLC
• Northwest Periodontics and Dental Implants LLC
• Northwest Permanente
• Northwest Permanente, P.C.
• Northwest Physical Therapy Care, LLC
• Northwest Primary Care Group PC

• Pediatric Nephrology Physician in Portland, OR
• Providers in Portland, OR by specialty
• Pediatric Nephrology Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 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.

Verify at the official NPI Registry.