NPIMap

Individual provider Active NPI

Mikelle Jenee Adamczyk, CRNA

  • Certified Registered Nurse Anesthetist
  • Portland, OR
National Provider Identifier
1053580936
Registry record updated Jun 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
201900978CRNA Issued in OR
Practice address
3181 SW Sam Jackson Park Rd
Portland, OR 97239-3011
Phone
(503) 494-7641
Fax
(503) 494-4661
NPI assigned
Feb 26, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 201900978CRNA OR Primary
Certified Registered Nurse Anesthetist 367500000X 4704217848 MI

Addresses

Primary practice location

3181 SW Sam Jackson Park Rd
Portland, OR 97239-3011

Mailing address

3181 SW Sam Jackson Park Rd
Mail Code SJH-2
Portland, OR 97239
Phone (503) 494-7246

Other practice location 1

16001 W 9 Mile Rd
Southfield, MI 48075-4818
Phone (248) 849-5806

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI, OR, ID, MN4 enrollments

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
I20080507000355 MI Practitioner - Certified Registered Nurse Anesthetist (Crna) 3375622939 Reassigns benefits to 2 organizations
I20191021003217 OR Practitioner - Certified Registered Nurse Anesthetist (Crna) 3375622939 Reassigns benefits to 2 organizations
I20250716002585 ID Practitioner - Certified Registered Nurse Anesthetist (Crna) 3375622939 Reassigns benefits to 1 organization
I20251223000999 MN Practitioner - Certified Registered Nurse Anesthetist (Crna) 3375622939 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Alphonsus Professional Medical Services LLCGroup PAC ID 7214849751, 124 clinicians
Allina Health SystemGroup PAC ID 4587573613, 3,844 clinicians
University Anesthesiology Associates LLCGroup PAC ID 6901702869, 239 clinicians

Practice addresses (Care Compare)

1055 N Curtis Rd
Boise, ID 83706-1309
Phone (208) 367-2152

2925 Chicago Ave
Minneapolis, MN 55407-1321
Phone (651) 262-7633

3181 SW Sam Jackson Park Rd
Portland, OR 97239-3011
Phone (503) 494-7641

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3260MNMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
Allina Health System CurrentSince Dec 2, 2025 Accepting new patients
University Anesthesiology Associates, LLC CurrentSince Oct 4, 2019 Accepting new patients
St Alphonsus Professional Medical Services LLC CurrentSince Aug 31, 2025 Accepting new patients
St Alphonsus Professional Medical Services LLC CurrentSince Aug 31, 2025 Accepting new patients
Allina Health System CurrentSince Dec 2, 2025 Accepting new patients
Anesthesia Associates Northwest LLC CurrentSince May 1, 2023 Accepting new patients
Northstar Anesthesia of Michigan II PC Nurse Anesthetist, Certified Registered CurrentSince Jul 1, 2012 Accepting new patients

Locations

1055 N Curtis Rd
Boise, ID 83706
Phone (208) 367-2152

30055 Northwestern Hwy
Ste L-60
Farmington Hills, MI 48334
Phone (248) 265-6555

3400 E Jolly Rd
Lansing, MI 48910
Phone (517) 272-1063

26750 Providence Pkwy
Ste 100
Novi, MI 48374
Phone (248) 662-1500

701 Dellwood St S
Cambridge, MN 55008
Phone (763) 689-7700

2925 Chicago Ave
Minneapolis, MN 55407
Phone (612) 262-4813

3181 SW Sam Jackson Park Rd
Portland, OR 97239
Phone (503) 494-5674

4805 NE Glisan St
Portland, OR 97213
Phone (503) 215-1111

3181 SW Sam Jackson Park Rd
#2
Portland, OR 97239
Phone (503) 494-4910

120 NW 14th Ave
Ste 200
Portland, OR 97209
Phone (503) 771-1883

Interoperability endpoints

  • Direct secure messaging: madamczyk118236@direct.ohsu.edu

Organizations & group practices 9

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.

Hospital & facility affiliations 29

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 29

NPI Registry JSON

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

{
    "created_epoch": "1203984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750204800000",
    "number": "1053580936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3181 SW SAM JACKSON PARK RD",
            "address_2": "MAIL CODE SJH-2",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97239",
            "telephone_number": "503-494-7246",
            "fax_number": "503-494-8368"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3181 SW SAM JACKSON PARK RD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972393011",
            "telephone_number": "503-494-7641",
            "fax_number": "503-494-4661"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16001 W 9 Mile Rd",
            "address_purpose": "LOCATION",
            "city": "Southfield",
            "state": "MI",
            "postal_code": "480754818",
            "country_code": "US",
            "telephone_number": "248-849-5806",
            "fax_number": "248-849-5489",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ADAMCZYK",
        "first_name": "MIKELLE",
        "middle_name": "JENEE",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-02-26",
        "last_updated": "2025-06-18",
        "certification_date": "2025-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "OR",
            "license": "201900978CRNA",
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MI",
            "license": "4704217848",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.

Verify at the official NPI Registry.