Active NPI
Michelle Lee Dykstra, PHD
- Clinical Psychologist
- Oregon City, OR
National Provider Identifier
1013072586
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 1412
- Practice address
- 610 Jefferson St
Oregon City, OR 97045 - Phone
- (503) 657-7235
- Fax
- (503) 657-7676
- NPI assigned
- Dec 26, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 1412 | OR | Primary |
Addresses
Primary practice location
610 Jefferson St
Oregon City, OR 97045
Mailing address
610 Jefferson St
Oregon City, OR 97045
Phone (503) 657-7235
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 279270 | Other | MHN HMC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1984
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
610 Jefferson St
Oregon City, OR 97045-2329
Phone (503) 657-7235
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167091200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1013072586",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "610 JEFFERSON ST",
"city": "OREGON CITY",
"state": "OR",
"postal_code": "97045",
"telephone_number": "503-657-7235",
"fax_number": "503-657-7676"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "610 JEFFERSON ST",
"city": "OREGON CITY",
"state": "OR",
"postal_code": "97045",
"telephone_number": "503-657-7235",
"fax_number": "503-657-7676"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DYKSTRA",
"first_name": "MICHELLE",
"middle_name": "LEE",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OR",
"license": "1412",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MHN HMC",
"identifier": "279270",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Oregon City, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.