NPIMap

Organization Active NPI

Northwest Spokane Pediatrics, PLLC

Doing business as Northwest Spokane Pediatrics

  • Pediatric Nurse Practitioner
  • Spokane, WA
National Provider Identifier
1952525636
Registry record updated Sep 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
Legal business name
NORTHWEST SPOKANE PEDIATRICS, PLLC
Doing business as
Northwest Spokane Pediatrics
Practice address
220 E Rowan Ave Ste 150
Spokane, WA 99207-2244
Phone
(509) 483-4060
Fax
(509) 483-0043
NPI assigned
Apr 12, 2007
Last updated
Sep 11, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2019

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

Authorized official

Name
Levi Jordan, RN
Title
Administrator
Phone
(509) 866-4646

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X NU
Primary Care Clinic/Center 261QP2300X 602279511 WA
Pediatric Nurse Practitioner 363LP0200X NU Primary
Occupational Therapist 225X00000X NU

Addresses

Primary practice location

220 E Rowan Ave Ste 150
Spokane, WA 99207-2244

Mailing address

220 E Rowan Ave Ste 150
Spokane, WA 99207-2244
Phone (509) 483-4060

Other identifiers 1

IdentifierTypeStateIssuer
1302215MedicaidWA

Other names 2

  • NORTHWEST SPOKANE PEDIATRICS Doing business as
  • JOSEPH B MCMANUS MD Former legal business name

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
50D0856695Northwest Spokane Pediatrics220 E Rowan Ave Ste 150, Spokane, WA 99207Certificate of waiverApr 4, 2028

National Provider Directory

National Provider Directory

Locations

220 E Rowan Ave
Ste 150
Spokane, WA 99207
Phone (509) 483-4060

5901 N Lidgerwood St
Ste 220
Spokane, WA 99208
Phone (509) 483-4060

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1176336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1568160000000",
    "number": "1952525636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 E ROWAN AVE STE 150",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992072244",
            "telephone_number": "509-483-4060",
            "fax_number": "509-483-0043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 E ROWAN AVE STE 150",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992072244",
            "telephone_number": "509-483-4060",
            "fax_number": "509-483-0043"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST SPOKANE PEDIATRICS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-12",
        "last_updated": "2019-09-11",
        "status": "A",
        "authorized_official_last_name": "JORDAN",
        "authorized_official_first_name": "LEVI",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "509-866-4646",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "WA",
            "license": "602279511",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1302215",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NORTHWEST SPOKANE PEDIATRICS",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "JOSEPH B MCMANUS MD",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Spokane, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.