NPIMap

Individual provider Active NPI

Andrew B Mendenhall, MD

  • Addiction Medicine (Family Medicine) Physician
  • Portland, OR
National Provider Identifier
1053347591
Registry record updated Jan 31, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction Medicine (Family Medicine) PhysicianTaxonomy code 207QA0401X
License
MD24383 Issued in OR
Practice address
1535 N Williams Ave
Portland, OR 97227-1885
Phone
(503) 238-2067
Fax
(503) 238-2004
NPI assigned
Jun 25, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD24383 OR
Addiction Medicine (Family Medicine) Physician 207QA0401X MD24383 OR Primary

Addresses

Primary practice location

1535 N Williams Ave
Portland, OR 97227-1885

Mailing address

232 NW 6TH Ave
Portland, OR 97209-3609
Phone (503) 294-1681

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260202003662 OR Order and Referring Only - Family PracticePractitioner - Family Practice 3678469574

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD24383ORMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cleanslate Medical Group of Virginia, LLC PastSince Nov 28, 2018 Accepting new patients
Boulder Care Provider Group PA Addiction Medicine PastSince Apr 18, 2019 Accepting new patients
Central City Concern, Inc PastSince Jul 1, 2022 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: amendenhall665432@direct.ochin.org

Ownership & related parties

All facility ownership & control disclosures 12

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Central City Concern, Inc.Portland, OR, CCN 381811 Federally qualified health center Corporate Officer
W-2 Managing Employee		 Jul 1, 2022
Jul 1, 2022
Central City Concern, Inc.Portland, OR, CCN 381914 Federally qualified health center Corporate Officer
W-2 Managing Employee		 Jul 1, 2022
Jul 1, 2022
Central City Concern, Inc.Portland, OR, CCN 381984 Federally qualified health center Corporate Officer
Corporate Director
W-2 Managing Employee		 Jul 1, 2022
Jul 1, 2022
Jul 1, 2022
Central City Concern, Inc.Portland, OR, CCN 931001 Federally qualified health center Corporate Officer
W-2 Managing Employee		 Jul 1, 2022
Jul 1, 2022
Central City Concern, Inc.Portland, OR, CCN 381024 Federally qualified health center Corporate Officer
W-2 Managing Employee
Operational/Managerial Control		 Jul 1, 2022
Jul 1, 2022
Jul 1, 2022
Central City Concern, Inc.Portland, OR, CCN 381026 Federally qualified health center Corporate Officer
W-2 Managing Employee
Operational/Managerial Control		 Jul 1, 2022
Jul 1, 2022
Jul 1, 2022
Central City Concern, Inc.Portland, OR, CCN 381043 Federally qualified health center Corporate Officer
Corporate Director
W-2 Managing Employee
Operational/Managerial Control		 Jul 1, 2022
Jul 1, 2022
Jul 1, 2022
Jul 1, 2022
Central City Concern, Inc.Portland, OR, CCN 381041 Federally qualified health center Corporate Officer
W-2 Managing Employee
Operational/Managerial Control		 Jul 1, 2022
Jul 1, 2022
Jul 1, 2022
Central City Concern, Inc.Portland, OR, CCN 381042 Federally qualified health center Corporate Officer
W-2 Managing Employee
Operational/Managerial Control		 Jul 1, 2022
Jul 1, 2022
Jul 1, 2022
Central City Concern, Inc.Portland, OR, CCN 381044 Federally qualified health center Corporate Officer
W-2 Managing Employee
Operational/Managerial Control		 Jul 1, 2022
Jul 1, 2022
Jul 1, 2022
Central City Concern, Inc.Portland, OR, CCN 381047 Federally qualified health center Corporate Officer
W-2 Managing Employee
Operational/Managerial Control		 Jul 1, 2022
Jul 1, 2022
Jul 1, 2022
Central City Concern, Inc.Portland, OR, CCN 381052 Federally qualified health center Corporate Officer
W-2 Managing Employee
Operational/Managerial Control		 Jul 1, 2022
Jul 1, 2022
Jul 1, 2022

Owned or controlled facilities with NPI records 13

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

View all 13

Organizations & group practices 22

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1151193600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1517356800000",
    "number": "1053347591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "232 NW 6TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972093609",
            "telephone_number": "503-294-1681",
            "fax_number": "503-241-7419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1535 N WILLIAMS AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972271885",
            "telephone_number": "503-238-2067",
            "fax_number": "503-238-2004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENDENHALL",
        "first_name": "ANDREW",
        "middle_name": "B",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-25",
        "last_updated": "2018-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "MD24383",
            "primary": false
        },
        {
            "code": "207QA0401X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "OR",
            "license": "MD24383",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.