Individual provider Active NPI

Marie Louise Dhulst, MD

  • Internal Medicine Physician
  • Portland, OR
National Provider Identifier
1093882789
Registry record updated Nov 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD20104 Issued in OR
Practice address
800 SW 13TH Ave
Portland, OR 97205
Phone
(503) 221-0161
Fax
(503) 274-1697
NPI assigned
Nov 29, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD20104 OR Primary

Addresses

Primary practice location

800 SW 13TH Ave
Portland, OR 97205

Mailing address

800 SW 13TH Ave
Portland, OR 97205
Phone (503) 221-0161

Other identifiers 1

IdentifierTypeStateIssuer
151346MedicaidOR

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mdhulst1705@direct.theportlandclinic.net

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: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110110000158 OR Practitioner - Internal Medicine 5597954354 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Hahnemann University College of Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Portland ClinicGroup PAC ID 8224942867, 93 clinicians

Practice addresses (Care Compare)

800 SW 13TH Ave
Portland, OR 97205-1902
Phone 50322101612110

9250 SW Hall Blvd
Tigard, OR 97223-6721
Phone (503) 293-0161

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

Interoperability endpoints

  • Direct secure messaging: mdhulst1705@direct.theportlandclinic.net
  • Direct secure messaging: mdhulst31985@theportlandclinic.gardenplot.direct-ci.com

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604620800000",
    "number": "1093882789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 SW 13TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97205",
            "telephone_number": "503-221-0161",
            "fax_number": "503-274-1697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 SW 13TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97205",
            "telephone_number": "503-221-0161",
            "fax_number": "503-274-1697"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DHULST",
        "first_name": "MARIE LOUISE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-29",
        "last_updated": "2020-11-06",
        "certification_date": "2020-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "MD20104",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "151346",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mdhulst1705@direct.theportlandclinic.net",
            "affiliation": "N",
            "address_1": "800 SW 13th Ave",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "97205",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.