Individual provider Active NPI

Maria Luisa Constante, MD

  • Family Medicine Physician
  • Portland, OR
National Provider Identifier
1104856285
Registry record updated Oct 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD17452 Issued in OR
Practice address
1321 NE 99TH Ave
Suite 200
Portland, OR 97220-9436
Phone
(503) 215-4250
Fax
(503) 215-4255
NPI assigned
Jul 4, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD17452 OR Primary

Addresses

Primary practice location

1321 NE 99TH Ave
Suite 200
Portland, OR 97220-9436

Mailing address

PO Box 3158
Portland, OR 97208-3158
Phone (503) 215-6494

Other identifiers 2

IdentifierTypeStateIssuer
P00214110OtherORRR MEDICARE
031927MedicaidOR

Other names 1

  • Mary Lou Constante Other name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mconstante117616@oc.providencedirect.org

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
I20041210000718 OR Practitioner - Family Practice 6608833694 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Washington School of Medicine, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Providence Health and Services OregonGroup PAC ID 0648183608, 1,423 clinicians

Practice addresses (Care Compare)

1321 NE 99TH Ave
Suite 200
Portland, OR 97220-9439
Phone (503) 215-4250

Hospital & facility affiliations

  • Providence Portland Medical Center Hospital, Portland, OR, CCN 380061

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

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services Oregon CurrentSince Jan 1, 2005 Accepting new patients
Providence Health & Services Oregon Current Accepting new patients
Providence Health & Services - Oregon Family Medicine CurrentSince Jan 1, 2005 Accepting new patients

Locations

5279 N Lombard St
Portland, OR 97203
Phone (503) 215-3300

1321 NE 99th Ave
Ste 200
Portland, OR 97220
Phone (503) 215-4250

5050 NE Hoyt St
Ste 240
Portland, OR 97213
Phone (503) 215-6480

Interoperability endpoints

  • Direct secure messaging: mconstante117616@oc.providencedirect.org

Organizations & group practices 3

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601856000000",
    "number": "1104856285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3158",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083158",
            "telephone_number": "503-215-6494",
            "fax_number": "503-215-6644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1321 NE 99TH AVE",
            "address_2": "SUITE 200",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972209436",
            "telephone_number": "503-215-4250",
            "fax_number": "503-215-4255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONSTANTE",
        "first_name": "MARIA",
        "middle_name": "LUISA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-04",
        "last_updated": "2020-10-05",
        "certification_date": "2020-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "MD17452",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00214110",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "031927",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mconstante117616@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "1321 NE 99th Ave",
            "address_2": "Suite 200",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972209436",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MARY LOU",
            "last_name": "CONSTANTE",
            "credential": "MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.