NPIMap

Individual provider Active NPI

Mary Carroll Lee, M.D.

  • Emergency Medicine Physician
  • Portland, OR
National Provider Identifier
1184003279
Registry record updated Jan 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
MD193202 Issued in OR
Practice address
3181 SW Sam Jackson Park Rd
Portland, OR 97239-3011
Phone
(503) 494-7551
NPI assigned
May 22, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Emergency Medicine Physician 207P00000X MD193202 OR Primary

Addresses

Primary practice location

3181 SW Sam Jackson Park Rd
Portland, OR 97239-3011

Mailing address

3181 SW Sam Jackson Park Rd
Portland, OR 97239-3011
Phone (503) 494-7551

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190820002285 OR Practitioner - Emergency Medicine 3779890611 Reassigns benefits to 7 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Medical College of Georgia School of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University Professional ServicesGroup PAC ID 4880760107, 1,683 clinicians

Practice addresses (Care Compare)

3181 SW Sam Jackson Park Rd
Portland, OR 97239-3011
Phone (503) 494-8311

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
University Professional Services CurrentSince Sep 1, 2021 Accepting new patients
Mid-Columbia Medical Center CurrentSince Sep 1, 2021 Accepting new patients
University Professional Services CurrentSince Sep 1, 2021 Accepting new patients
Mid-Columbia Medical Center CurrentSince Sep 1, 2021 Accepting new patients
Peacehealth CurrentSince Apr 27, 2024 Accepting new patients
Healthcare for the Mid-Columbia Region Emergency Medicine Current Accepting new patients
Columbia Lutheran Charities CurrentSince Oct 3, 2025 Accepting new patients
University Professional Services Current Accepting new patients
Columbia Lutheran Charities CurrentSince Oct 3, 2025 Accepting new patients
Peacehealth Current Accepting new patients
Columbia Lutheran Charities CurrentSince Oct 3, 2025 Accepting new patients
Salem Emergency Physicians Service, PC Emergency Medicine CurrentSince Aug 15, 2019 Accepting new patients
Columbia Lutheran Charities Past Accepting new patients
Mid-Columbia Medical Center Past Accepting new patients
Columbia Lutheran Charities Past Accepting new patients

Locations

2111 Exchange St
Astoria, OR 97103
Phone (503) 325-4321

15700 SW Greystone Ct
Beaverton, OR 97006
Phone (503) 203-1000

400 9th St
Florence, OR 97439
Phone (541) 997-8412

3181 SW Sam Jackson Park Rd
Portland, OR 97239
Phone (503) 494-5674

890 Oak St SE
Bldg A
Salem, OR 97301
Phone (503) 370-5634

1700 E 19th St
The Dalles, OR 97058
Phone (541) 296-7251

1805 E 19th St
The Dalles, OR 97058
Phone (541) 296-2201

Interoperability endpoints

  • Direct secure messaging: mlee135936@direct.ohsu.edu
  • Direct secure messaging: mlee68567@direct.carilionclinic.org
  • Direct secure messaging: mlee544476@direct.peacehealth.org

Organizations & group practices 15

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.

View all 15

Hospital & facility affiliations 6

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": "1432252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641427200000",
    "number": "1184003279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3181 SW SAM JACKSON PARK RD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972393011",
            "telephone_number": "503-494-7551",
            "fax_number": "503-494-4997"
        },
        {
            "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": "972393011",
            "telephone_number": "503-494-7551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "MARY CARROLL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-05-22",
        "last_updated": "2022-01-06",
        "certification_date": "2022-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OR",
            "license": "MD193202",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.