NPIMap

Organization Active NPI

Northwest Renal Clinic, Inc.

  • Nephrology Physician
  • Portland, OR
National Provider Identifier
1982931333
Registry record updated Jul 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
NORTHWEST RENAL CLINIC, INC.
Practice address
4224 NE Halsey St Ste 300
Portland, OR 97213-1568
Phone
(503) 235-5509
Fax
(503) 235-5335
NPI assigned
Nov 5, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2023

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

Authorized official

Name
Clayton M Smiley
Title
MD
Phone
(503) 229-7976

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RN0300X Primary

Addresses

Primary practice location

4224 NE Halsey St Ste 300
Portland, OR 97213-1568

Mailing address

1130 NW 22ND Ave
Suite 640
Portland, OR 97210-5488
Phone (503) 229-7976

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040429000295 OR Part B Supplier - Clinic/Group Practice 8628065836 Receives reassigned benefits from 38 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Portland, OR; Tualatin, OR; Salem, OR; McMinnville, OR; Hillsboro, OR; Clackamas, OR

Other NPIs on the same Medicare enrollment 9

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

National Provider Directory

National Provider Directory

Locations

5050 NE Hoyt St
Ste B54
Portland, OR 97213

1130 NW 22nd Ave
Ste 640
Portland, OR 97210
Phone (503) 229-7976

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1257379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689120000000",
    "number": "1982931333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1130 NW 22ND AVE",
            "address_2": "SUITE 640",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972105488",
            "telephone_number": "503-229-7976",
            "fax_number": "503-274-4867"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4224 NE HALSEY ST STE 300",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972131568",
            "telephone_number": "503-235-5509",
            "fax_number": "503-235-5335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST RENAL CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-05",
        "last_updated": "2023-07-12",
        "certification_date": "2023-07-12",
        "status": "A",
        "authorized_official_last_name": "SMILEY",
        "authorized_official_first_name": "CLAYTON",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "503-229-7976"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "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 Jul 12, 2023; 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.