Matilda Martha Mengis, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

MD23525 Issued in OR

Practice address

412 SW 12TH Ave
Portland, OR 97205-2329

Phone

(503) 228-7134

Fax

(503) 273-8431

NPI assigned

Nov 29, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Central City Concern

  • Substance Abuse Rehabilitation Facility
  • Portland, OR
  • NPI 1679832315
  NPD (past)
• Central City Concern, Inc

  • Federally Qualified Health Center (FQHC)
  • Portland, OR
  • NPI 1548071848
  NPD (past)

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

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1174690838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2721 SW MONTGOMERY DR",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972011692",
            "telephone_number": "503-936-2324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "412 SW 12TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972052329",
            "telephone_number": "503-228-7134",
            "fax_number": "503-273-8431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENGIS",
        "first_name": "MATILDA",
        "middle_name": "MARTHA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-29",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "G83302",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "OR",
            "license": "MD23525",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "286525",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Xiao Meng, PHARM.D.
• Xiao Yang Meng, RDH
• Yuxuan Meng
• Emily Ann Menghini, LPC
• Ryan Menghini, MSW
• Chad Lewis Menicosy
• Laurie Menk Otto, ND
• Forest Menke-Thielman
• Dawn Leslie Menken
• Menlo Park SNF Healthcare LLC (Menlo Park Post Acute)

• Psychiatry Physician in Portland, OR
• Providers in Portland, OR by specialty
• Psychiatry Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.