NPIMap

Organization Active NPI

Patrick Radecki, M.D. a Professional Corporation

  • Specialist
  • Portland, OR
National Provider Identifier
1992855829
Registry record updated Oct 13, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
MD13579 Issued in OR
Legal business name
PATRICK RADECKI, M.D. A PROFESSIONAL CORPORATION
Practice address
2222 NW Lovejoy St Ste 607
Portland, OR 97210-5104
Phone
(503) 222-3638
Fax
(503) 222-3638
NPI assigned
Jan 11, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2008

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

Authorized official

Name
Dr. Patrick L. Radecki, MD
Title
Owner
Phone
(503) 222-3638

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X MD13579 OR Primary

Addresses

Primary practice location

2222 NW Lovejoy St Ste 607
Portland, OR 97210-5104

Mailing address

2222 NW Lovejoy St Ste 607
Portland, OR 97210-5104
Phone (503) 222-3638

Other identifiers 1

IdentifierTypeStateIssuer
291880MedicaidOR

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1168473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1223856000000",
    "number": "1992855829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2222 NW LOVEJOY ST STE 607",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972105104",
            "telephone_number": "503-222-3638",
            "fax_number": "503-222-3638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2222 NW LOVEJOY ST STE 607",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972105104",
            "telephone_number": "503-222-3638",
            "fax_number": "503-222-3638"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATRICK RADECKI, M.D. A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-11",
        "last_updated": "2008-10-13",
        "status": "A",
        "authorized_official_last_name": "RADECKI",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-222-3638",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "OR",
            "license": "MD13579",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "291880",
            "state": "OR"
        }
    ],
    "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 Oct 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.