Active NPI
Kenneth Paul Melvin, MD
- Internal Medicine Physician
- Lake Oswego, OR
National Provider Identifier
1013971837
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- MD 24232
- Practice address
- 4035 Mercantile Dr
Suite 112
Lake Oswego, OR 97035-2546 - Phone
- (503) 203-1177
- Fax
- (503) 203-1178
- NPI assigned
- Apr 17, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | MD 24232 | OR | Primary |
Addresses
Primary practice location
4035 Mercantile Dr
Suite 112
Lake Oswego, OR 97035-2546
Mailing address
6975 SW Sandburg St
Suite 190
Portland, OR 97223-8073
Phone (503) 639-0600
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 269812 | Medicaid | OR | |
| MD24232 | Other | OR | MEDICAL LICENCE NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD 24232 | OR | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Uptown Providers Inc | Past | Accepting new patients | |
| Uptown Providers PC | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Urgent Care Clinic/Center
- Portland, OR
- NPI 1134563620
-
- General Practice Physician
- Portland, OR
- NPI 1144598293
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145232000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1013971837",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6975 SW SANDBURG ST",
"address_2": "SUITE 190",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972238073",
"telephone_number": "503-639-0600"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4035 MERCANTILE DR",
"address_2": "SUITE 112",
"city": "LAKE OSWEGO",
"state": "OR",
"postal_code": "970352546",
"telephone_number": "503-203-1177",
"fax_number": "503-203-1178"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MELVIN",
"first_name": "KENNETH",
"middle_name": "PAUL",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-04-17",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "OR",
"license": "MD 24232",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "269812",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAL LICENCE NUMBER",
"identifier": "MD24232",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lake Oswego, OR
Sources for this page
- 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.