Active NPI
James Allen Katancik, DDS, PHD
- Periodontics
- Portland, OR
National Provider Identifier
1891818340
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- DF0025
- Practice address
- 2730 SW Moody Ave
Sdperi
Portland, OR 97201-5042 - Phone
- (503) 494-4891
- NPI assigned
- Apr 9, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | DF0025 | OR | Primary |
Addresses
Primary practice location
2730 SW Moody Ave
Sdperi
Portland, OR 97201-5042
Mailing address
2730 SW Moody Ave
Sdperi
Portland, OR 97201-5042
Phone (503) 494-4891
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DF0025 | OR | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176076800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1435622400000",
"number": "1891818340",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2730 SW MOODY AVE",
"address_2": "SDPERI",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972015042",
"telephone_number": "503-494-4891"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2730 SW MOODY AVE",
"address_2": "SDPERI",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972015042",
"telephone_number": "503-494-4891"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KATANCIK",
"first_name": "JAMES",
"middle_name": "ALLEN",
"name_prefix": "Dr.",
"credential": "DDS, PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-09",
"last_updated": "2015-06-30",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "OR",
"license": "DF0025",
"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 Jun 30, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.