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PEDIATRIC TLC PC
NPI 1548930464
Nurse Practitioner - Pediatrics in Grants Pass, OR

Active since September 14, 2021CLIA 38D2055904 · Waiver
1819 NEBRASKA AVE, GRANTS PASS, OR 97527(541) 479-2411 Get Directions Write a Review

NPPES record last updated: August 25, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Aug 25, 2022, Sep 14, 2021 (2 updates tracked since 2021).

About Pediatric Tlc Pc NPPES

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

PEDIATRIC TLC PC (NPI 1548930464) is a healthcare organization registered as a pediatrics in Grants Pass, Oregon and active in the NPI registry since September 2021. The organization holds a CLIA Waiver certificate valid through March 18, 2027 and lists Yvonne Martenia, Owner, as its authorized official.

NPPES Registry Identity

NPI1548930464
Entity TypeOrganization
Primary Taxonomy363LP0200X
Legal Business NamePEDIATRIC TLC PC
Location Address1819 NEBRASKA AVEGrants Pass, OR 97527-5701
Mailing Address1819 Nebraska AveGrants Pass, OR 97527-5701 · (541) 479-2411
Phone(541) 479-2411
Organization SubpartNo
Authorized OfficialYvonne MarteniaOwner · (547) 479-2411
Enumeration DateSeptember 14, 2021
Last NPPES UpdateAugust 25, 20222 updates tracked since enumeration
NPPES CertifiedAugust 25, 2022
✔ NPI 1548930464 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · PediatricsPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP0200X
1819 NEBRASKA AVE, Grants Pass, OR 97527
Open in Google Maps ↗

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 BridgeSpan Health Company, Moda Health Plan, Inc., Regence BlueCross BlueShield of Oregon.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 38D2055904

Pediatric Tlc PC · Grants Pass, OR
Active · expires Mar 18, 2027
CLIA Number38D2055904
Laboratory TypePractitioner Other
Certificate Effective DateMarch 19, 2025
Certificate Expiration DateMarch 18, 2027
Laboratory DirectorMartenia Yvonne
Laboratory Phone(541) 479-2411
Laboratory LocationPediatric Tlc PC1819 Nebraska Ave, Grants Pass, OR 97527
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

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

YVONNE RENEE MARTENIA FNP-BC
Nurse Practitioner (Family)
1819 NEBRASKA AVE
GRANTS PASS, OR 97527
Josephine County (541) 479-2411

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 Pediatric Tlc PC's NPI number?

The NPI number for Pediatric Tlc PC is 1548930464. It was assigned to this organization in the NPPES registry on September 14, 2021.

Where is Pediatric Tlc PC located?

Pediatric Tlc PC is located at 1819 Nebraska Ave, Grants Pass, OR 97527. The listed phone number is (541) 479-2411.

What is Pediatric Tlc PC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Pediatrics, with taxonomy code 363LP0200X.

Does Pediatric Tlc PC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 38D2055904) is associated with this NPI, valid through March 18, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Pediatric Tlc PC accept?

Health plans from BridgeSpan Health Company, Moda Health Plan, Inc. and Regence BlueCross BlueShield of Oregon list Pediatric Tlc 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 Pediatric Tlc PC was last updated on August 25, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.