NPIMap

Organization Active NPI

Kaiser Permanente Dental Care Program

  • Dentist
  • Portland, OR
National Provider Identifier
1861918005
Registry record updated Jun 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
KAISER PERMANENTE DENTAL CARE PROGRAM
Practice address
2930 NE Dekum St
Portland, OR 97211-6613
Phone
(800) 813-2000
Fax
(503) 286-6879
NPI assigned
Aug 18, 2017
Organization subpart
Yes
Parent organization
KAISER FOUNDATION HEALTH PLAN OF THE NWAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 1, 2021

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

Authorized official

Name
Mrs. Amy Marko
Title
Dental Business Leader
Phone
(503) 813-4660

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X Primary
Dental HygienistGroup: 193200000X MULTI-SPECIALTY GROUP 124Q00000X

Addresses

Primary practice location

2930 NE Dekum St
Portland, OR 97211-6613

Mailing address

500 NE Multnomah St
Portland, OR 97232-2023
Phone (800) 813-2000

Other identifiers 1

IdentifierTypeStateIssuer
XXXXXMedicaidOR

Other names 1

  • Kaiser Permanente 3 to PhD Dental Other name

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/interconnect-prodnwm/wcf/epic.community.hie/xcpdrespondinggateways Health Information Exchange (HIE)

National Provider Directory

National Provider Directory
Tax ID family
Permananet Clinic150 organizations share this tax ID, including this one
Part of
Permananet Clinic

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1503014400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622505600000",
    "number": "1861918005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 NE MULTNOMAH ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972322023",
            "telephone_number": "800-813-2000",
            "fax_number": "503-286-6879"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2930 NE DEKUM ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972116613",
            "telephone_number": "800-813-2000",
            "fax_number": "503-286-6879"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KAISER PERMANENTE DENTAL CARE PROGRAM",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KAISER FOUNDATION HEALTH PLAN OF THE NW",
        "enumeration_date": "2017-08-18",
        "last_updated": "2021-06-01",
        "certification_date": "2021-06-01",
        "status": "A",
        "authorized_official_last_name": "MARKO",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "DENTAL BUSINESS LEADER",
        "authorized_official_telephone_number": "503-813-4660",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "124Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dental Hygienist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "XXXXX",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/interconnect-prodnwm/wcf/epic.community.hie/xcpdrespondinggateways",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "2930 NE Dekum St",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972116613",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Kaiser Permanente 3 to PhD Dental",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Jun 1, 2021; 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.