NPIMap

Organization Active NPI

University Professional Services

Doing business as University Professional Services in SW Washington

  • Clinic/Center
  • Vancouver, WA
National Provider Identifier
1881848307
Registry record updated Mar 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
UNIVERSITY PROFESSIONAL SERVICES
Doing business as
University Professional Services in SW Washington
Practice address
16701 SE McGillivray Blvd Ste 170
Vancouver, WA 98683-3604
Phone
(360) 260-7132
NPI assigned
Nov 11, 2008
Last updated
Mar 13, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
UNIVERSITY PROFESSIONAL SERVICESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 13, 2024

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

Authorized official

Name
Kelly Anne Smith
Title
VP, Enterprise Revenue Cycle
Phone
(503) 494-8760

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU Primary
Ophthalmology Physician 207W00000X NU
Pediatrics Physician 208000000X NU

Addresses

Primary practice location

16701 SE McGillivray Blvd Ste 170
Vancouver, WA 98683-3604

Mailing address

3181 SW Sam Jackson Park Rd
Portland, OR 97239-3011
Phone (503) 494-8300

Other names 1

  • University Professional Services in SW Washington Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081222000088 WA Part B Supplier - Clinic/Group Practice 4880760107 Receives reassigned benefits from 47 practitioners
1 other NPI on this enrollment
Practice locations: Vancouver, WA; White Salmon, WA; Walla Walla, WA; Longview, WA

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Oregon Health Science University

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

16701 SE McGillivray Blvd
Ste 150
Vancouver, WA 98683

16701 SE McGillivray Blvd
Ste 170
Vancouver, WA 98683
Phone (360) 260-7132

301 W Poplar St
Ste 100
Walla Walla, WA 99362
Phone (509) 522-5824

Practitioners & affiliated clinicians

Practitioners 49

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.

View all 49

NPI Registry JSON

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

{
    "created_epoch": "1226361600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710288000000",
    "number": "1881848307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3181 SW SAM JACKSON PARK RD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972393011",
            "telephone_number": "503-494-8300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16701 SE MCGILLIVRAY BLVD STE 170",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986833604",
            "telephone_number": "360-260-7132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY PROFESSIONAL SERVICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "UNIVERSITY PROFESSIONAL SERVICES",
        "enumeration_date": "2008-11-11",
        "last_updated": "2024-03-13",
        "certification_date": "2024-03-13",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "ANNE",
        "authorized_official_title_or_position": "VP, ENTERPRISE REVENUE CYCLE",
        "authorized_official_telephone_number": "503-494-8760"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "University Professional Services in SW Washington",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Vancouver, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 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.