Northwest Spine Surgery LLC

Primary specialty

Orthopaedic Surgery of the Spine PhysicianTaxonomy code 207XS0117X

Legal business name

NORTHWEST SPINE SURGERY LLC

Practice address

10,000 SE Main St St 360
Portland, OR 97216

Phone

(503) 253-4000

Fax

(503) 253-4002

NPI assigned

Mar 26, 2024

Last updated

Jul 10, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Emerald Louise Nelson Flores

Title

Clinic Administrator

Phone

(971) 277-0559

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Practitioners 5

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.

• Laurens Foster Johansen, MD

  • Family Medicine Physician
  • West Linn, OR
  • NPI 1083683247
  Medicare reassignment Care Compare group NPD
• Serena Esmee Blythe Liu, MD

  • Orthopaedic Surgery Physician
  • Clackamas, OR
  • NPI 1629572284

  Orthopaedic Surgery of the Spine

  Medicare reassignment Care Compare group NPD
• Kendrick Michael Khoo, M.D.

  • Orthopaedic Surgery Physician
  • Sacramento, CA
  • NPI 1891158663

  OR

  Medicare reassignment Care Compare group NPD
• Megan E Nichols, PA-C

  • Physician Assistant
  • Sandy, OR
  • NPI 1932885621
  Medicare reassignment
• Wesley Wenzel, PA-C

  • Physician Assistant
  • Portland, OR
  • NPI 1639688708
  Medicare reassignment

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

{
    "created_epoch": "1711411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720569600000",
    "number": "1841040292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10000 SE MAIN ST STE 360",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972162474",
            "telephone_number": "503-253-4000",
            "fax_number": "503-253-4002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10,000 SE MAIN ST ST 360",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97216",
            "telephone_number": "503-253-4000",
            "fax_number": "503-253-4002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST SPINE SURGERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-26",
        "last_updated": "2024-07-10",
        "certification_date": "2024-07-10",
        "status": "A",
        "authorized_official_last_name": "NELSON FLORES",
        "authorized_official_first_name": "EMERALD",
        "authorized_official_middle_name": "LOUISE",
        "authorized_official_title_or_position": "CLINIC ADMINISTRATOR",
        "authorized_official_telephone_number": "971-277-0559"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207XS0117X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Northwest Surgical Specialists, P.C. (Rebound Orthopedics & Neurosurgical Specialists)
• Northwest Urological Clinic PC
• Northwest Urology, LLC

• Orthopaedic Surgery of the Spine Physician in Portland, OR
• Providers in Portland, OR by specialty
• Orthopaedic Surgery of the Spine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2024; 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.

Verify at the official NPI Registry.