Individual provider Active NPI

Imani Elizabeth McElroy, MD

  • Vascular Surgery Physician
  • Portland, OR
National Provider Identifier
1164942397
Registry record updated Sep 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
A194137 Issued in CA
Practice address
3181 SW Sam Jackson Park Rd
Portland, OR 97239-3098
Phone
(503) 494-8311
NPI assigned
Jun 20, 2017
Last updated
Sep 16, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery Physician 2086S0129X A194137 CA Primary
Vascular Surgery Physician 2086S0129X MD230403 OR
Vascular Surgery Physician 2086S0129X MD.MD.70134189 WA

Addresses

Primary practice location

3181 SW Sam Jackson Park Rd
Portland, OR 97239-3098

Mailing address

1130 NW 12TH Ave Apt 308
Portland, OR 97209-2855
Phone (650) 576-8722

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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
I20170817000591 MA Order and Referring Only - General SurgeryPractitioner - General Surgery 6901178540

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A194137CAMDSurgery Physician

NPI Registry JSON

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

{
    "created_epoch": "1497916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1789516800000",
    "number": "1164942397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1130 NW 12TH AVE APT 308",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972092855",
            "telephone_number": "650-576-8722"
        },
        {
            "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": "972393098",
            "telephone_number": "503-494-8311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCELROY",
        "first_name": "IMANI",
        "middle_name": "ELIZABETH",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-20",
        "last_updated": "2026-09-16",
        "certification_date": "2026-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "CA",
            "license": "A194137",
            "primary": true
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "OR",
            "license": "MD230403",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "WA",
            "license": "MD.MD.70134189",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.