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WESTSIDE PEDIATRIC CLINIC PC
NPI 1093929226
Pediatrics in Portland, OR

Active since May 09, 2007CLIA 38D0624959 · Waiver
9555 SW BARNES RD, SUITE 270, PORTLAND, OR 97225(503) 297-1025(503) 297-1043 Get Directions Write a Review

NPPES record last updated: April 11, 2008. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Westside Pediatric Clinic Pc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

WESTSIDE PEDIATRIC CLINIC PC (NPI 1093929226) is a healthcare organization registered as a pediatrics in Portland, Oregon and active in the NPI registry since May 2007. The organization holds a CLIA Waiver certificate valid through September 11, 2026 and lists Connie Lynn Distefano, Administrator, as its authorized official.

NPPES Registry Identity

NPI1093929226
Entity TypeOrganization
Primary Taxonomy208000000X
Legal Business NameWESTSIDE PEDIATRIC CLINIC PC
Location Address9555 SW BARNES RD, SUITE 270Portland, OR 97225
Mailing Address9555 Sw Barnes Rd, Suite 270Portland, OR 97225 · (503) 297-1025 · Fax (503) 297-1043
Phone(503) 297-1025
Fax(503) 297-1043
Organization SubpartNo
Authorized OfficialConnie Lynn DistefanoAdministrator · (503) 297-1025
Enumeration DateMay 9, 2007
Last NPPES UpdateApril 11, 2008
✔ NPI 1093929226 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
Definition
A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.
9555 SW BARNES RD, Portland, OR 97225
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Other Identifiers 1

Medicaid150220OR

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Moda Health Plan, Inc., Providence Health Plan.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 38D0624959

Westside Pediatric Clinic, PC · Portland, OR
Active · expires Sep 11, 2026
CLIA Number38D0624959
Laboratory TypePhysician Office
Certificate Effective DateSeptember 12, 2024
Certificate Expiration DateSeptember 11, 2026
Laboratory DirectorFaye Johnson
Laboratory Phone(503) 297-1025
Laboratory LocationWestside Pediatric Clinic, PC9555 SW Barnes Rd #270, Portland, OR 97225
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JOANNE G DEVORE MD
Pediatrics
9555 SW BARNES RD, STE 301
PORTLAND, OR 97225
Washington County (503) 297-3371
DODI L WADE MSN, PNP
Nurse Practitioner (Pediatrics)
9555 SW BARNES RD, SUITE 301
PORTLAND, OR 97225
Washington County (503) 535-6338
MRS. ELISABETH HAYDEN HOLT MAKLER WHCNP, ANP
Nurse Practitioner (Women's Health)
9555 SW BARNES RD, SUITE 100
PORTLAND, OR 97225
Washington County (503) 292-3577
ROBERT J GILLESPIE MD
Pediatrics
9555 SW BARNES RD, STE 301
PORTLAND, OR 97225
Washington County (503) 297-3371
SUNSET SURGICAL CENTRE LLC
Clinic/Center (Ambulatory Surgical)
9555 SW BARNES RD, SUITE 275
PORTLAND, OR 97225
Washington County (503) 297-8555
HELEN C WELCH CNM
Advanced Practice Midwife
9555 SW BARNES RD, SUITE 100
PORTLAND, OR 97225
Washington County (503) 292-3577
EYE HEALTH NORTHWEST OPTICAL, LLC
Eyewear Supplier
9555 SW BARNES RD, SUITE 201
PORTLAND, OR 97225
Washington County (503) 227-2020
EMILY LAWSON ARNP,CNM
Advanced Practice Midwife
9555 SW BARNES RD, SUITE 100
PORTLAND, OR 97225
Washington County (503) 292-3577

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Westside Pediatric Clinic PC's NPI number?

The NPI number for Westside Pediatric Clinic PC is 1093929226. It was assigned to this organization in the NPPES registry on May 9, 2007.

Where is Westside Pediatric Clinic PC located?

Westside Pediatric Clinic PC is located at 9555 SW Barnes Rd Suite 270, Portland, OR 97225. The listed phone number is (503) 297-1025.

What is Westside Pediatric Clinic PC's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Does Westside Pediatric Clinic PC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 38D0624959) is associated with this NPI, valid through September 11, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Westside Pediatric Clinic PC accept?

Health plans from Moda Health Plan, Inc. and Providence Health Plan list Westside Pediatric Clinic PC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Westside Pediatric Clinic PC was last updated on April 11, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.