Active NPI
Michael H Walczyk, MD
- Nephrology Physician
- Portland, OR
National Provider Identifier
1871562892
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nephrology Physician
- License
- 13217
- Practice address
- 1130 NW 22ND Ave Ste 400
Portland, OR 97210-2971 - Phone
- (503) 413-6722
- Fax
- (503) 413-6563
- NPI assigned
- Mar 14, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nephrology Physician | 207RN0300X | 23874 | WA | |
| Nephrology Physician | 207RN0300X | MD19676 | HI | |
| Nephrology Physician | 207RN0300X | 13217 | OR | Primary |
Addresses
Primary practice location
1130 NW 22ND Ave Ste 400
Portland, OR 97210-2971
Mailing address
PO Box 4037
Portland, OR 97208-4037
Phone (503) 413-4048
Other practice location 1
1130 NW 22nd Ave Ste 640
Portland, OR 97210-2993
Phone (503) 229-7976
Other practice location 2
75 Puuhonu Pl Ste 100
Hilo, HI 96720-2000
Phone (808) 935-8647
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 147116 | Medicaid | OR | |
| 1029586 | Medicaid | WA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD19676 | HI | MD | Nephrology Physician |
| 13217 | OR | MD | Nephrology Physician |
| 23874 | WA | MD | Nephrology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142294400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1578960000000",
"number": "1871562892",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 4037",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972084037",
"telephone_number": "503-413-4048",
"fax_number": "503-413-2910"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1130 NW 22ND AVE STE 400",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972102971",
"telephone_number": "503-413-6722",
"fax_number": "503-413-6563"
}
],
"practiceLocations": [
{
"address_1": "1130 NW 22nd Ave Ste 640",
"address_purpose": "LOCATION",
"city": "Portland",
"state": "OR",
"postal_code": "972102993",
"country_code": "US",
"telephone_number": "503-229-7976",
"fax_number": "503-274-4867",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "75 Puuhonu Pl Ste 100",
"address_purpose": "LOCATION",
"city": "Hilo",
"state": "HI",
"postal_code": "967202000",
"country_code": "US",
"telephone_number": "808-935-8647",
"fax_number": "808-935-9783",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WALCZYK",
"first_name": "MICHAEL",
"middle_name": "H",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-14",
"last_updated": "2020-01-14",
"certification_date": "2020-01-14",
"status": "A"
},
"taxonomies": [
{
"code": "207RN0300X",
"taxonomy_group": "",
"desc": "Internal Medicine, Nephrology",
"state": "WA",
"license": "23874",
"primary": false
},
{
"code": "207RN0300X",
"taxonomy_group": "",
"desc": "Internal Medicine, Nephrology",
"state": "HI",
"license": "MD19676",
"primary": false
},
{
"code": "207RN0300X",
"taxonomy_group": "",
"desc": "Internal Medicine, Nephrology",
"state": "OR",
"license": "13217",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "147116",
"state": "OR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1029586",
"state": "WA"
}
],
"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 Jan 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.