Active NPI
Jeffrey B Melnick, PA
- Physician Assistant
- Tigard, OR
National Provider Identifier
1245273374
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA00251
- Practice address
- 12442 SW Scholls Ferry Rd
Suite 100
Tigard, OR 97223-3396 - Phone
- (503) 215-9900
- Fax
- (503) 216-9266
- NPI assigned
- Jun 14, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA00251 | OR | Primary |
Addresses
Primary practice location
12442 SW Scholls Ferry Rd
Suite 100
Tigard, OR 97223-3396
Mailing address
PO Box 13994
Portland, OR 97213-0994
Phone (503) 215-6494
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)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA00251 | OR | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150243200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1196208000000",
"number": "1245273374",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 13994",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972130994",
"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": "12442 SW SCHOLLS FERRY RD",
"address_2": "SUITE 100",
"city": "TIGARD",
"state": "OR",
"postal_code": "972233396",
"telephone_number": "503-215-9900",
"fax_number": "503-216-9266"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MELNICK",
"first_name": "JEFFREY",
"middle_name": "B",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-14",
"last_updated": "2007-11-28",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "OR",
"license": "PA00251",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tigard, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 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.