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CHILDRENS CLINIC PC
NPI 1316137235
Pediatrics in Tualatin, OR

Active since July 26, 2007CLIA Certified · 2 labs
19260 SW 65TH AVE, STE 340, TUALATIN, OR 97062(503) 691-9777(503) 692-6736 Get Directions Write a Review

NPPES record last updated: April 28, 2020. Verified against the NPPES registry weekly; last sync: November 08, 2026.

About Childrens Clinic Pc NPPES

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

CHILDRENS CLINIC PC (NPI 1316137235) is a healthcare organization registered as a pediatrics in Tualatin, Oregon and active in the NPI registry since July 2007. The organization holds 2 active CLIA laboratory certificates and lists Kelsey Durham, Health Plan Coordinator, as its authorized official.

NPPES Registry Identity

NPI1316137235
Entity TypeOrganization
Primary Taxonomy208000000X
Legal Business NameCHILDRENS CLINIC PC
Location Address19260 SW 65TH AVE, STE 340Tualatin, OR 97062-5701
Mailing Address9555 Sw Barnes Rd, Ste 301Portland, OR 97225-6663 · (503) 297-3371 · Fax (503) 297-7975
Phone(503) 691-9777
Fax(503) 692-6736
Organization SubpartNo
Authorized OfficialKelsey DurhamHealth Plan Coordinator · (503) 535-6314
Enumeration DateJuly 26, 2007
Last NPPES UpdateApril 28, 2020
NPPES CertifiedApril 28, 2020
✔ NPI 1316137235 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.
19260 SW 65TH AVE, Tualatin, OR 97062
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Other Identifiers 1

Medicaid500730975OR

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

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Childrens Clinic Pc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

3

Medicare enrollment records show 3 clinicians reassign Medicare billing to Childrens Clinic PC, which bills Medicare for the services they deliver. Of these, 3 practice within 10 miles. They are listed nearest first.

Clinicians, nearest first (3)

Julie Fiene Yeager, MD
Pediatric Medicine
NPI 1114916137
19260 SW 65TH AVE STE 340
Tualatin, OR 97062
(503) 691-9777
✔ PECOS0.2 mi
Susanne Purnell, MD
Pediatric Medicine
NPI 1891784815
3181 SW SAM JACKSON PARK RD
Portland, OR 97239
(503) 418-5710
✔ PECOS8.8 mi
Smita Tomkoria, MD
Pediatric Medicine
NPI 1609865625
9555 SW BARNES RD STE 301
Portland, OR 97225
(503) 297-3371
✔ PECOS9.3 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA 2

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 Compliance 38D0881216

Children's Clinic, The · Tualatin, OR
Active · expires Sep 6, 2028
CLIA Number38D0881216
Laboratory TypePhysician Office
Certificate Effective DateSeptember 7, 2026
Certificate Expiration DateSeptember 6, 2028
Laboratory DirectorJazmin A. Diarra
Laboratory Phone(503) 691-9777
Laboratory LocationChildren's Clinic, The19260 SW 65th Avenue Suite #340, Tualatin, OR 97062
CLIA data matches this NPI record on: Address Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Certificate of Compliance 38D0670371

Children's Clinic Portland, The · Portland, OR
Active · expires Jul 25, 2027
CLIA Number38D0670371
Laboratory TypePhysician Office
Certificate Effective DateJuly 26, 2025
Certificate Expiration DateJuly 25, 2027
Laboratory DirectorJazmin A. Diarra
Laboratory Phone(503) 297-3371
Laboratory LocationChildren's Clinic Portland, The9450 SW Barnes Rd Suite 200, Portland, OR 97225
CLIA data matches this NPI record on: Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

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 Childrens Clinic PC's NPI number?

The NPI number for Childrens Clinic PC is 1316137235. It was assigned to this organization in the NPPES registry on July 26, 2007.

Where is Childrens Clinic PC located?

Childrens Clinic PC is located at 19260 SW 65th Ave Ste 340, Tualatin, OR 97062. The listed phone number is (503) 691-9777.

What is Childrens Clinic PC's specialty?

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

Is Childrens Clinic PC enrolled in Medicare?

Yes. Childrens Clinic PC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Childrens Clinic PC?

According to the CMS Revalidation Reassignment List (October 2026 release), 3 clinicians, all in Pediatric Medicine, reassign their Medicare billing to Childrens Clinic PC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 3 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Childrens Clinic PC hold CLIA laboratory certificates?

Yes. 2 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

When was this NPI record last updated?

The NPPES record for Childrens Clinic PC was last updated on April 28, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.