Active NPI
Northwest Extremity Specialists LLC
- Podiatrist
- Portland, OR
National Provider Identifier
1295126241
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Podiatrist
- Legal business name
- NORTHWEST EXTREMITY SPECIALISTS LLC
- Practice address
- 9115 SW Oleson Rd Ste 205
Portland, OR 97223-6877 - Phone
- (503) 245-2420
- NPI assigned
- Feb 12, 2015
- Last updated
- Feb 8, 2021
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Thomas Charles Melillo, DPM
- Title
- Owner
- Phone
- (503) 245-2420
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatrist | 213E00000X | NU | Primary |
Addresses
Primary practice location
9115 SW Oleson Rd Ste 205
Portland, OR 97223-6877
Mailing address
9115 SW Oleson Rd Ste 205
Portland, OR 97223-6877
Phone (503) 245-2420
Other practice location 1
5499 Amy St
West Linn, OR 97068-3320
Phone (503) 655-0775
Other practice location 2
10690 NE Cornell Rd Ste 212
Hillsboro, OR 97124-9224
Phone (503) 245-2420
Other practice location 3
16770 SW Edy Rd Ste 318
Sherwood, OR 97140-9678
Phone (503) 245-2420
Other practice location 4
2222 NW Lovejoy St Ste 510
Portland, OR 97210-5103
Phone (503) 221-1581
Other practice location 5
201 N Washington St
Newberg, OR 97132-2727
Phone (503) 538-0800
Other practice location 6
1000 N Providence Dr Ste 320
Newberg, OR 97132-7582
Phone (503) 245-2420
Other practice location 7
6542 SE Lake Rd Ste 102
Milwaukie, OR 97222-2245
Phone (503) 659-6686
Other practice location 8
5050 NE Hoyt St Ste 411
Portland, OR 97213-2983
Phone (503) 643-1737
Other practice location 9
12658 SE Stark St Bldg H
Portland, OR 97233-1058
Phone (503) 221-1581
Other practice location 10
12400 NW Cornell Rd Ste 201
Portland, OR 97229-5689
Phone (503) 643-1737
Other practice location 11
18040 SW Lower Boones Ferry Rd Ste 207
Tigard, OR 97224-7259
Phone (503) 245-2420
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150420000860 | OR | Part B Supplier - Clinic/Group Practice | 3577881747 |
Receives reassigned benefits from 23 practitioners Practice locations: Milwaukie, OR; West Linn, OR; Tigard, OR; Sherwood, OR; Portland, OR; Newberg, OR |
| O20210219000602 | OR | DME Supplier - Physician - Podiatry | 3577881747 | Practice locations: Portland, OR |
Other NPIs with the same Medicare PAC ID 1
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
National Provider Directory
National Provider DirectoryLocations
201 N Washington St
Newberg, OR 97132
Phone (503) 538-0800
2222 NW Lovejoy St
Ste 510
Portland, OR 97210
Phone (503) 221-1581
Practitioners & affiliated clinicians
Practitioners 23
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Foot & Ankle Surgery Podiatrist
- Portland, OR
- NPI 1619085479
-
- Orthopaedic Surgery Physician
- Portland, OR
- NPI 1902849771
-
- Foot & Ankle Surgery Podiatrist
- Tigard, OR
- NPI 1154338275
-
- Physical Therapist
- Sherwood, OR
- NPI 1356342661
-
- Foot Surgery Podiatrist
- Wilsonville, OR
- NPI 1356452247
-
- Podiatrist
- Tigard, OR
- NPI 1629048533
-
- Foot & Ankle Surgery Podiatrist
- Portland, OR
- NPI 1285977470
-
- Foot & Ankle Surgery Podiatrist
- Salem, OR
- NPI 1497149454
-
- Foot & Ankle Surgery Podiatrist
- Portland, OR
- NPI 1962454934
-
- Medical Physician Assistant
- Medford, OR
- NPI 1861802944
-
- Anatomic Pathology & Clinical Pathology Physician
- Tigard, OR
- NPI 1184744351
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1423699200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1612742400000",
"number": "1295126241",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9115 SW OLESON RD STE 205",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972236877",
"telephone_number": "503-245-2420"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9115 SW OLESON RD STE 205",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972236877",
"telephone_number": "503-245-2420"
}
],
"practiceLocations": [
{
"address_1": "5499 Amy St",
"address_purpose": "LOCATION",
"city": "West Linn",
"state": "OR",
"postal_code": "970683320",
"country_code": "US",
"telephone_number": "503-655-0775",
"fax_number": "503-655-0751",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "10690 NE Cornell Rd Ste 212",
"address_purpose": "LOCATION",
"city": "Hillsboro",
"state": "OR",
"postal_code": "971249224",
"country_code": "US",
"telephone_number": "503-245-2420",
"fax_number": "503-245-2445",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "16770 SW Edy Rd Ste 318",
"address_purpose": "LOCATION",
"city": "Sherwood",
"state": "OR",
"postal_code": "971409678",
"country_code": "US",
"telephone_number": "503-245-2420",
"fax_number": "503-245-2445",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2222 NW Lovejoy St Ste 510",
"address_purpose": "LOCATION",
"city": "Portland",
"state": "OR",
"postal_code": "972105103",
"country_code": "US",
"telephone_number": "503-221-1581",
"fax_number": "503-221-1582",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "201 N Washington St",
"address_purpose": "LOCATION",
"city": "Newberg",
"state": "OR",
"postal_code": "971322727",
"country_code": "US",
"telephone_number": "503-538-0800",
"fax_number": "503-554-8408",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1000 N Providence Dr Ste 320",
"address_purpose": "LOCATION",
"city": "Newberg",
"state": "OR",
"postal_code": "971327582",
"country_code": "US",
"telephone_number": "503-245-2420",
"fax_number": "503-245-2445",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "6542 SE Lake Rd Ste 102",
"address_purpose": "LOCATION",
"city": "Milwaukie",
"state": "OR",
"postal_code": "972222245",
"country_code": "US",
"telephone_number": "503-659-6686",
"fax_number": "503-905-6202",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "5050 NE Hoyt St Ste 411",
"address_purpose": "LOCATION",
"city": "Portland",
"state": "OR",
"postal_code": "972132983",
"country_code": "US",
"telephone_number": "503-643-1737",
"fax_number": "503-643-4926",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "12658 SE Stark St Bldg H",
"address_purpose": "LOCATION",
"city": "Portland",
"state": "OR",
"postal_code": "972331058",
"country_code": "US",
"telephone_number": "503-221-1581",
"fax_number": "503-221-1582",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "12400 NW Cornell Rd Ste 201",
"address_purpose": "LOCATION",
"city": "Portland",
"state": "OR",
"postal_code": "972295689",
"country_code": "US",
"telephone_number": "503-643-1737",
"fax_number": "503-643-4926",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "18040 SW Lower Boones Ferry Rd Ste 207",
"address_purpose": "LOCATION",
"city": "Tigard",
"state": "OR",
"postal_code": "972247259",
"country_code": "US",
"telephone_number": "503-245-2420",
"fax_number": "503-245-2445",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"organization_name": "NORTHWEST EXTREMITY SPECIALISTS LLC",
"organizational_subpart": "NO",
"enumeration_date": "2015-02-12",
"last_updated": "2021-02-08",
"certification_date": "2021-02-08",
"status": "A",
"authorized_official_last_name": "MELILLO",
"authorized_official_first_name": "THOMAS",
"authorized_official_middle_name": "CHARLES",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "503-245-2420",
"authorized_official_credential": "DPM"
},
"taxonomies": [
{
"code": "213E00000X",
"taxonomy_group": "",
"desc": "Podiatrist",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.