NPIMap

Organization Active NPI

Northwest Renal Clinic, Inc.

  • Nephrology Physician
  • Portland, OR
National Provider Identifier
1861700130
Registry record updated Jul 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
NORTHWEST RENAL CLINIC, INC.
Practice address
10201 SE Main St
Suite 27
Portland, OR 97216-2937
Phone
(503) 256-0877
Fax
(503) 256-4188
NPI assigned
Sep 20, 2010
Last updated
Jul 12, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2023

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

Authorized official

Name
Clayton M Smiley, MDNPI 1679544431
Title
MD
Phone
(503) 229-7976

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X Primary

Addresses

Primary practice location

10201 SE Main St
Suite 27
Portland, OR 97216-2937

Mailing address

10201 SE Main St
Suite 27
Portland, OR 97216-2937
Phone (503) 256-0877

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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 Inc9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Locations

10201 SE Main St
Ste 27
Portland, OR 97216
Phone (503) 256-0877

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1284940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689120000000",
    "number": "1861700130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10201 SE MAIN ST",
            "address_2": "SUITE 27",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972162937",
            "telephone_number": "503-256-0877",
            "fax_number": "503-256-4188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10201 SE MAIN ST",
            "address_2": "SUITE 27",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972162937",
            "telephone_number": "503-256-0877",
            "fax_number": "503-256-4188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST RENAL CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-20",
        "last_updated": "2023-07-12",
        "certification_date": "2022-12-13",
        "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": null,
            "license": null,
            "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 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.

Verify at the official NPI Registry.