Bert G Tavelli, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

MD 14681 Issued in OR

Practice address

2525 NW Lovejoy St Ste 400
Portland, OR 97210-2865

Phone

(503) 223-1933

Fax

(503) 223-1947

NPI assigned

Aug 2, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: btavelli@directaddress.net

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.

• NW Dermatology and Research Center, LLC

  • Dermatology Physician
  • Portland, OR
  • NPI 1679852396
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1122940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1013918978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2525 NW LOVEJOY ST STE 400",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972102865",
            "telephone_number": "503-223-1933",
            "fax_number": "503-223-1947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2525 NW LOVEJOY ST STE 400",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972102865",
            "telephone_number": "503-223-1933",
            "fax_number": "503-223-1947"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAVELLI",
        "first_name": "BERT",
        "middle_name": "G",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-02",
        "last_updated": "2023-03-07",
        "certification_date": "2021-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "OR",
            "license": "MD 14681",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samantha Tauscher
• Daniel Christian Tautenhan, LMT
• Matthew Tauzik
• Jacob Paul Tauzin, HIS
• Emmanuel Trungtoan Tavan, MD
• Jay Tavis
• Srilatha Tavisala, PHARM.D
• Sidhartha Tavri, M.D.
• Elliot Trustin Taxman, ND, MS
• Ci an Gerald Tay

• Dermatology Physician in Portland, OR
• Providers in Portland, OR by specialty
• Dermatology Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.