NORTHWEST RENAL CLINIC, INC. (NPI# 1861700130) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861700130 |
| Entity Type | Organization |
| Organization Name | NORTHWEST RENAL CLINIC, INC. |
| Practice Address |
10201 Se Main St Suite 27 Portland OR 97216-2937 |
| Practice Telephone | 5032560877 |
| Practice Fax Number | 5032564188 |
| Mailing Telephone | 5032560877 |
| Mailing Fax Number | 5032564188 |
| Enumeration Date | 2010-09-20 |
| Last Update Date | 2010-09-20 |
| Authorized Official Name | JONALYN HORSFALL (ADMINISTRATOR) |
| Authorized Official Telephone | 5032297976 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RN0300X |
Internal Medicine Specialization: Nephrology |
Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396378717 | Northwest Renal Clinic, Inc. | Internal Medicine | 925 Commercial St Se Ste 110, Salem, OR 97302-4172 | 2020-02-13 |
| 1164946984 | Northwest Renal Clinic, Inc. | Clinic/Center | 9701 Sw Barnes Rd Ste 110, Portland, OR 97225-6774 | 2017-08-02 |
| 1396924999 | Northwest Renal Clinic, Inc. | Internal Medicine | 9701 Sw Barnes Road, Suite 110, Portland, OR 97225 | 2007-10-31 |
| 1780228544 | Northwest Renal Clinic, Inc. | Internal Medicine | 105 Maui Lani Pkwy Ste 100, Wailuku, HI 96793-2443 | 2019-11-04 |
| 1689117087 | Northwest Renal Clinic, Inc. | Internal Medicine | 12550 Se 93rd Ave, Suite 250, Clackamas, OR 97015-9786 | 2016-12-02 |
| 1750748901 | Northwest Renal Clinic, Inc. | Internal Medicine | 730 Se Oak St, Suite I, Hillsboro, OR 97123-4245 | 2016-01-19 |
| 1982931333 | Northwest Renal Clinic, Inc. | Internal Medicine | 5050 Ne Hoyt St, Suite B-54, Portland, OR 97213-2991 | 2009-11-05 |
| 1780865642 | Northwest Renal Clinic, Inc. | Internal Medicine | 9155 Sw Barnes Rd, Suite 402, Portland, OR 97225-6625 | 2007-11-20 |
| 1679752273 | Northwest Renal Clinic, Inc. | Internal Medicine | 8050 Sw Warm Springs St, Suite 150, Tualatin, OR 97062-7424 | 2007-10-31 |
| 1528036662 | Northwest Renal Clinic, Inc. | Internal Medicine | 1130 Nw 22nd Ave, Ste 640, Portland, OR 97210-2993 | 2006-03-14 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | NORTHWEST RENAL CLINIC, INC. | 1130 Nw 22nd #640, Portland, OR 97210 |
| Street Address |
10201 SE MAIN ST SUITE 27 |
| City | PORTLAND |
| State | OR |
| Zip Code | 97216-2937 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598757452 | Samuel Albert Camacho | Internal Medicine | 10201 Se Main St, Suite 10, Portland, OR 97216-2937 | 2005-08-17 |
| 1316339229 | Jenna Clowers | Physician Assistant | 10201 Se Main St, Suite 9, Portland, OR 97216-2937 | 2015-03-02 |
| 1881919348 | Macy Ann Martinson | Internal Medicine | 10201 Se Main St, Suite 27, Portland, OR 97216-2937 | 2010-03-28 |
| 1215261920 | Ninfa Johnson Neuser | Counselor | 10201 Se Main St, Ste 10, Portland, OR 97216-2937 | 2009-09-28 |
| 1881851368 | Aumyot Prongdong | Internal Medicine | 10201 Se Main St, Suite 27, Portland, OR 97216-2937 | 2008-05-21 |
| 1205958576 | Vanessa L Peterson | Internal Medicine | 10201 Se Main St, Portland Lung Clinic, Portland, OR 97216-2937 | 2007-04-05 |
| 1477617512 | Kevin Khaw | Internal Medicine | 10201 Se Main St, Suite 25, Portland, OR 97216-2937 | 2006-12-21 |
| 1912079500 | Leonard R Bertheau | Family Medicine | 10201 Se Main St, Suite 10, Portland, OR 97216-2937 | 2006-11-15 |
| 1043318405 | Jeffrey Aaron Komisarof | Internal Medicine | 10201 Se Main St, Suite 27, Portland, OR 97216-2937 | 2006-09-20 |
| 1326157462 | Kidney Care Inc | Internal Medicine | 10201 Se Main St, Suite 27, Portland, OR 97216-2937 | 2006-08-30 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316468341 | Accident Care Chiropractic and Massage of Salem | Clinic/Center | 2168 Lancaster Dr. Ne, Portland, OR 97216 | 2017-06-29 |
| 1528508520 | Damone Brown | Peer Specialist | 10209 Se Washington St, Suite D, Portland, OR 97216 | 2017-02-24 |
| 1861937237 | Malachai Investments LLC | Clinical Medical Laboratory | 10,000 Se Main St, Ste 360, Portland, OR 97216 | 2016-12-21 |
| 1881136836 | Krista Marie Darnell | Occupational Therapy Assistant | 1475, Se 100th Avenue, Portland, OR 97216 | 2016-11-08 |
| 1821456559 | Sean Kelly | Counselor | 10564 Se Washington Street, Portland, OR 97216 | 2016-02-09 |
| 1174908321 | Phil Bergland | Counselor | 11220 Se Stark St, Suite 6, Portland, OR 97216 | 2015-07-29 |
| 1134507346 | Beth Lopez | Massage Therapist | 5814 Se Stark Street, Portland, OR 97216 | 2015-05-08 |
| 1982081477 | Amelia C Hunt | Counselor | 10564 Se Washinton Street, Portland, OR 97216 | 2015-05-04 |
| 1073907978 | Karen Ta | Emergency Medicine | 10300 Se Main St, Portland, OR 97216 | 2015-03-27 |
| 1265823298 | Laura Catherine Anderson | Occupational Therapist | 1475 Se 100th Avenue, Portland, OR 97216 | 2015-02-12 |
| Find all providers in zip 97216 | ||||
| Taxonomy Code | 207RN0300X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Nephrology |
| An internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184133746 | Abd Assalam Qannus | Internal Medicine | 22 Bramhall St Rm 5219, Portland, ME 04102-3134 | 2017-09-27 |
| 1023403748 | Sarah Gilligan | Internal Medicine | 19 Capisic St, Portland, ME 04102-2203 | 2015-03-31 |
| 1528487527 | Janie Luong | Internal Medicine | 10201 Se Main St Ste 27, Portland, OR 97216-2937 | 2014-04-08 |
| 1386074953 | David Alan Mccarron | Internal Medicine | 120 Nw 9th Ave, Suite 206, Portland, OR 97209-3324 | 2013-11-19 |
| 1578859849 | Thuy Xuan Le | Internal Medicine | 1040 Nw 22nd Ave Ste 480, Portland, OR 97210-3062 | 2011-06-24 |
| 1427348150 | Mark Nguyen | Internal Medicine | 1130 Nw 22nd Ave Ste 640, Portland, OR 97210-2993 | 2011-04-14 |
| 1720377039 | Robert Whitney Rope | Internal Medicine | 3181 Sw Sam Jackson Park Rd Mc Sjh6, Portland, OR 97239-3011 | 2011-04-07 |
| 1578707451 | Kate Schoolwerth Gustafson | Internal Medicine | 3710 Sw Us Veterans Hospital Rd # P3neph, Portland, OR 97239-2964 | 2009-04-23 |
| 1174777973 | Tricia Noelle Jesperson | Internal Medicine | 5050 Ne Hoyt St Ste B54, Portland, OR 97213 | 2008-11-06 |
| 1861677825 | Apolonia G. Silva | Internal Medicine | 6736 Ne Killingsworth Street La Clinica De Buena Salud, Portland, OR 97218-3338 | 2008-01-08 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.