Michelle Kabryn Pavlovich, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

L10610 Issued in OR

Practice address

800 SW 13TH Ave
Portland, OR 97205-1999

Phone

(503) 221-0161

Fax

(971) 713-7255

NPI assigned

Dec 7, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Michelle Kabryn Pelham Former name

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Senior Living Memory Health IncGroup PAC ID 7517480577, 113 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Senior Living Memory Health, Inc.

  • Clinical Psychologist
  • North Miami Beach, FL
  • NPI 1851847834
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1638835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638835200000",
    "number": "1336807353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 SW 13TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972051999",
            "telephone_number": "503-221-0161",
            "fax_number": "971-713-7255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 SW 13TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972051999",
            "telephone_number": "503-221-0161",
            "fax_number": "971-713-7255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAVLOVICH",
        "first_name": "MICHELLE",
        "middle_name": "KABRYN",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-12-07",
        "last_updated": "2021-12-07",
        "certification_date": "2021-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L10610",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHELLE",
            "last_name": "PELHAM",
            "middle_name": "KABRYN",
            "credential": "MSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Cole Pavelchek
• Alejandra Pavia-Herrera
• Brian Tihomir Pavic, M.D.
• Katelyn Deirdre Pavlat, MD
• Jessie Pavlinac, RD, LD
• Evgeny Pavlushkov, MD, PHD, FRCR
• Ta May Paw
• Anushka Pawashe
• Evan Pawlak
• Theodore David Pawlik, M.D.

• Clinical Social Worker in Portland, OR
• Providers in Portland, OR by specialty
• Clinical Social Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.