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Export Provider Record NPI 1093929226
Westside Pediatric Clinic Pc
Organization Subpart: NO
Active
NPI Number1093929226
NPI TypeNPI-2 Organization
SpecialtyPediatrics
Provider Details
NPI1093929226
NPI TypeNPI-2 Organization
StatusActive
Enumeration Date2007-05-09
Last Updated2008-04-11
Authorized OfficialConnie Distefano
Administrator
Phone: 5032971025
Mailing Address9555 Sw Barnes Rd, Suite 270
Portland, OR 97225
United States
Phone: (503) 297-1025 | Fax: (503) 297-1043
📍 View Map
Primary Practice Address9555 Sw Barnes Rd, Suite 270
Portland, OR 97225
United States
Phone: (503) 297-1025 | Fax: (503) 297-1043
📍 View Map
Other Identifiers
IssuerStateNumberOther Issuer
MEDICAIDOR150220
Taxonomy / Specialty
PrimaryTaxonomy Code & DescriptionStateLicense Number
Yes208000000X – Pediatrics
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About NPI 1093929226

Westside Pediatric Clinic Pc is an organization registered in the CMS NPPES NPI Registry with NPI number 1093929226. The primary specialty listed is Pediatrics. The organization is located in Portland, OR. This NPI is classified as a Type 2 (Organizational) NPI and is currently active. The NPI was first enumerated (assigned) on 2007-05-09. All data is sourced directly from the official CMS NPPES public API and is updated daily.

Frequently Asked Questions

What is NPI 1093929226?

NPI 1093929226 belongs to Westside Pediatric Clinic Pc, a Pediatrics in Portland, OR. It is a Type 2 Organizational NPI registered in the CMS NPPES NPI Registry.

Is NPI 1093929226 active?

The current status of NPI 1093929226 in the NPPES registry is Active. The record was last updated on 2008-04-11.

What specialty is NPI 1093929226?

NPI 1093929226 is classified under the taxonomy Pediatrics. Taxonomy codes in NPPES are maintained by the National Uniform Claim Committee (NUCC) and identify the provider's type, classification, and specialization.

How do I verify NPI 1093929226?

You can verify NPI 1093929226 at the official CMS NPPES website at npiregistry.cms.hhs.gov or using our free NPI Lookup tool above. All data shown on this page is sourced directly from the official NPPES public API and is updated daily by CMS.

What address is on file for NPI 1093929226?

The primary practice address on file for NPI 1093929226 is 9555 Sw Barnes Rd, Portland, OR 97225. This address is registered in the NPPES system and providers are required to update it within 30 days of any change.

When was NPI 1093929226 issued?

NPI 1093929226 was first issued (enumerated) on 2007-05-09. The NPPES record was last updated on 2008-04-11.

Practice Location Map

Westside Pediatric Clinic Pc is located at 9555 Sw Barnes Rd, Portland, OR. Use the map below to find directions or verify the practice location.

📍 9555 Sw Barnes Rd, Portland, OR 97225  ·  Open in Google Maps ↗

Related Healthcare Providers

The following providers share the same practice location, specialty, or state as Westside Pediatric Clinic Pc. All records sourced from the CMS NPPES registry.

Data Verified from CMS NPPES Last synced: 2026-06-24 · Source: npiregistry.cms.hhs.gov · 45 CFR Part 162