NPIMap

Individual provider Active NPI

Dominic Patrick Patillo, MD

  • Orthopaedic Hand Surgery Physician
  • Lake Oswego, OR
National Provider Identifier
1275649162
Registry record updated Aug 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Hand Surgery PhysicianTaxonomy code 207XS0106X
License
MD151644 Issued in OR
Practice address
17355 Lower Boones Ferry Rd
Ste 100a
Lake Oswego, OR 97035-2839
Phone
(503) 256-5866
Fax
(503) 254-0656
NPI assigned
Aug 22, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Hand Surgery Physician 207XS0106X MD151644 OR Primary
Orthopaedic Surgery Physician 207X00000X MD151644 OR

Addresses

Primary practice location

17355 Lower Boones Ferry Rd
Ste 100a
Lake Oswego, OR 97035-2839

Mailing address

17355 Lower Boones Ferry Rd
Ste 100a
Lake Oswego, OR 97035-2839
Phone (503) 256-5866

Other practice location 1

5050 NE Hoyt St Ste 668
Portland, OR 97213-2990
Phone (503) 224-8399

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
I20101123000597 OR Practitioner - Hand SurgeryPractitioner - Orthopedic Surgery 6709072291 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Hand SurgeryAlso: Orthopedic Surgery
Education
Washington University School of Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orthopedic and Sports Medicine Center of Oregon LLCGroup PAC ID 3678537602, 16 clinicians

Practice addresses (Care Compare)

17355 Lower Boones Ferry Rd
Suite 100a
Lake Oswego, OR 97035-2539
Phone (503) 224-8399

17355 Lower Boones Ferry Rd
Suite 100a
Lake Oswego, OR 97035-5202

Hospital & facility affiliations

  • Providence Portland Medical Center Hospital, Portland, OR, CCN 380061
  • Legacy Good Samaritan Medical Center Hospital, Portland, OR, CCN 380017
  • Adventist Health Tillamook Hospital, Tillamook, OR, CCN 381317

Merit-based Incentive Payment System (MIPS)

Final score
0 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
0

Procedures performed for Medicare patients

ProcedureNumber of procedures
Upper limb (arm) arthroscopy (minimally invasive joint repair)13
Removal of tissue1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Orthopedic & Sports Medicine Center of Or LLC Orthopaedic Surgery CurrentSince Nov 30, 2015 Accepting new patients
Orthopedic & Sports Medicine Center of Oregon LLC Orthopaedic Surgery CurrentSince Nov 30, 2015 Accepting new patients

Locations

17355 Boones Ferry Rd
Ste 100A
Lake Oswego, OR 97035
Phone (503) 256-5866

1515 NW 18th Ave
Ste 300
Portland, OR 97209

5050 NE Hoyt St
Ste 668
Portland, OR 97213
Phone (503) 239-7099

Organizations & group practices 2

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 8

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": "1156204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756080000000",
    "number": "1275649162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17355 LOWER BOONES FERRY RD",
            "address_2": "STE 100A",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970352839",
            "telephone_number": "503-256-5866",
            "fax_number": "503-254-0656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17355 LOWER BOONES FERRY RD",
            "address_2": "STE 100A",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970352839",
            "telephone_number": "503-256-5866",
            "fax_number": "503-254-0656"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5050 NE Hoyt St Ste 668",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972132990",
            "country_code": "US",
            "telephone_number": "503-224-8399",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PATILLO",
        "first_name": "DOMINIC",
        "middle_name": "PATRICK",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-22",
        "last_updated": "2025-08-25",
        "certification_date": "2025-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XS0106X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Hand Surgery",
            "state": "OR",
            "license": "MD151644",
            "primary": true
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "OR",
            "license": "MD151644",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Oswego, OR

Sources for this page

Verify at the official NPI Registry.