NPIMap

Organization Active NPI

Northwest Extremity Specialists, LLC

  • Foot & Ankle Surgery Podiatrist
  • Portland, OR
National Provider Identifier
1336511435
Registry record updated Jan 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
DP00330 Issued in OR
Legal business name
NORTHWEST EXTREMITY SPECIALISTS, LLC
Practice address
9115 SW Oleson Rd Ste 205
Portland, OR 97223-6877
Phone
(503) 245-2420
Fax
(503) 245-2445
NPI assigned
Oct 28, 2015
Last updated
Jan 6, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2021

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

Authorized official

Name
Thomas Charles Melillo, DPMNPI 1619085479
Title
Owner
Phone
(503) 245-2420

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery Podiatrist 213ES0103X DP00330 OR 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

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1445990400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1609891200000",
    "number": "1336511435",
    "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",
            "fax_number": "503-245-2445"
        },
        {
            "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",
            "fax_number": "503-245-2445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST EXTREMITY SPECIALISTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-28",
        "last_updated": "2021-01-06",
        "certification_date": "2021-01-06",
        "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": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "OR",
            "license": "DP00330",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2021; 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.