Active NPI
Andrew Lee Summerer, PSYD
- Clinical Psychologist
- Portland, OR
National Provider Identifier
1063946176
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 3280
- Practice address
- 2279 NW Irving St
Portland, OR 97210-3222 - Phone
- (503) 218-3667
- NPI assigned
- Apr 14, 2017
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 3280 | OR | Primary |
Addresses
Primary practice location
2279 NW Irving St
Portland, OR 97210-3222
Mailing address
2279 NW Irving St
Portland, OR 97210-3222
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
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210128001023 | OR | Practitioner - Clinical Psychologist | 2062826399 | Practice locations: Portland, OR |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
2279 NW Irving St
Portland, OR 97210-3222
Phone (503) 218-3667
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3280 | OR | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1492128000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1746403200000",
"number": "1063946176",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2279 NW IRVING ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972103222"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2279 NW IRVING ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972103222",
"telephone_number": "503-218-3667"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUMMERER",
"first_name": "ANDREW",
"middle_name": "LEE",
"name_prefix": "Mr.",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-04-14",
"last_updated": "2025-05-05",
"certification_date": "2025-05-05",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OR",
"license": "3280",
"primary": true
}
],
"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 May 5, 2025; 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.