Individual provider Active NPI

Sharlene Matthieu, M.D.

  • Pediatrics Physician
  • Portland, OR
National Provider Identifier
1104817741
Registry record updated Jul 29, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
MD25706 Issued in OR
Practice address
10000 SE Main St
Suite 105
Portland, OR 97216-2448
Phone
(503) 255-3544
Fax
(503) 251-6827
NPI assigned
Nov 2, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X MD25706 OR Primary

Addresses

Primary practice location

10000 SE Main St
Suite 105
Portland, OR 97216-2448

Mailing address

10000 SE Main St
Suite 30
Portland, OR 97216-2448
Phone (503) 255-3544

Other identifiers 1

IdentifierTypeStateIssuer
269734MedicaidOR

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
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD25706ORMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
East Portland Pediatric Clinic, P.C. Pediatrics Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: smatthieu154639@direct.ohsu.edu

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": "1130889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1375056000000",
    "number": "1104817741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10000 SE MAIN ST",
            "address_2": "SUITE 30",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972162448",
            "telephone_number": "503-255-3544",
            "fax_number": "503-251-6827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10000 SE MAIN ST",
            "address_2": "SUITE 105",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972162448",
            "telephone_number": "503-255-3544",
            "fax_number": "503-251-6827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATTHIEU",
        "first_name": "SHARLENE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-02",
        "last_updated": "2013-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OR",
            "license": "MD25706",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "269734",
            "state": "OR"
        }
    ],
    "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 Jul 29, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.