NPIMap

Individual provider Active NPI

Maisie L. Shindo, M.D.

  • Otolaryngology Physician
  • Portland, OR
National Provider Identifier
1386663672
Registry record updated Nov 8, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
MD28632 Issued in OR
Practice address
3181 SW Sam Jackson Park Road PV01
Portland, OR 97239
Phone
(503) 494-2544
Fax
(503) 494-4631
NPI assigned
Jul 18, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 205752 NY
Otolaryngology Physician 207Y00000X MD28632 OR Primary

Addresses

Primary practice location

3181 SW Sam Jackson Park Road PV01
Portland, OR 97239

Mailing address

3181 SW Sam Jackson Park Road PV01
Portland, OR 97239
Phone (503) 494-2544

Other identifiers 4

IdentifierTypeStateIssuer
01716861MedicaidNY
024306MedicaidOR
4638790OtherNYAETNA
01Z212OtherNYEMPIRE BC.BS

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
I20080922000134 OR Practitioner - Otolaryngology 3476620212 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
University of Southern California Keck School of Medicine, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
University Professional ServicesGroup PAC ID 4880760107, 1,683 clinicians

Practice addresses (Care Compare)

15700 SW Greystone CT
Beaverton, OR 97006-6011
Phone (503) 494-3442

3181 SW Sam Jackson Park Rd
Portland, OR 97239-3011
Phone (503) 494-8311

3303 S Bond Ave
Portland, OR 97239-4501
Phone (503) 494-8311

Hospital & facility affiliations

  • Ohsu Hospital and Clinics Hospital, Portland, OR, CCN 380009
  • Adventist Health Tillamook Hospital, Tillamook, OR, CCN 381317
  • Samaritan Pacific Community Hospital Hospital, Newport, OR, CCN 381314

Merit-based Incentive Payment System (MIPS)

Final score
99.11 of 100Reported as apm
Quality
84.29
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
205752NYMDOtolaryngology Physician
MD28632ORMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University Professional Services CurrentSince Jan 1, 2009 Accepting new patients
University Professional Services Current Accepting new patients
Stony Brook Radiology, University Faculty Practice Corporation Past Accepting new patients
Stony Brook Surgical Associates, University Faculty Practice Corporati Past Accepting new patients
University Professional Services Past Accepting new patients

Locations

15700 SW Greystone Ct
Beaverton, OR 97006
Phone (503) 203-1000

3181 SW Sam Jackson Park Rd
Portland, OR 97239
Phone (503) 494-5674

3181 SW Sam Jackson Park Rd
#1
Portland, OR 97239
Phone (503) 494-5355

Interoperability endpoints

  • Direct secure messaging: mshindomd19568@direct.ohsu.edu

Organizations & group practices 5

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 18

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1352332800000",
    "number": "1386663672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3181 SW SAM JACKSON PARK ROAD PV01",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97239",
            "telephone_number": "503-494-2544",
            "fax_number": "503-494-4631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3181 SW SAM JACKSON PARK ROAD PV01",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97239",
            "telephone_number": "503-494-2544",
            "fax_number": "503-494-4631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHINDO",
        "first_name": "MAISIE",
        "middle_name": "L.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-18",
        "last_updated": "2012-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "NY",
            "license": "205752",
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "OR",
            "license": "MD28632",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01716861",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "024306",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4638790",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMPIRE BC.BS",
            "identifier": "01Z212",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.