Active NPI
Mary Ellen Ulmer, MD
- Pediatrics Physician
- Beaverton, OR
National Provider Identifier
1396836870
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- MD21482
- Practice address
- 15950 SW Millikan Way
Beaverton, OR 97006 - Phone
- (503) 646-0161
- Fax
- (503) 643-7459
- NPI assigned
- Sep 27, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | MD21482 | OR | Primary |
Addresses
Primary practice location
15950 SW Millikan Way
Beaverton, OR 97006
Mailing address
800 SW 13TH Ave
Portland, OR 97205-1902
Phone (503) 221-0161
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 135239 | Medicaid | OR |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | mulmer1767@direct.theportlandclinic.net |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pediatric Associates of the Northwest, PC | Pediatrics | Past | Accepting new patients |
Interoperability endpoints
- mulmer@panw.pcc-direct.com
Organizations & group practices 1
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.
-
- Pediatrics Physician
- Beaverton, OR
- NPI 1528066859
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159315200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1606262400000",
"number": "1396836870",
"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": "972051902",
"telephone_number": "503-221-0161"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15950 SW MILLIKAN WAY",
"city": "BEAVERTON",
"state": "OR",
"postal_code": "97006",
"telephone_number": "503-646-0161",
"fax_number": "503-643-7459"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ULMER",
"first_name": "MARY",
"middle_name": "ELLEN",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-27",
"last_updated": "2020-11-25",
"certification_date": "2020-11-25",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "OR",
"license": "MD21482",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "135239",
"state": "OR"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "mulmer1767@direct.theportlandclinic.net",
"affiliation": "N",
"address_1": "15950 SW Millikan Way",
"city": "Beaverton",
"state": "OR",
"country_code": "US",
"postal_code": "97006",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Beaverton, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.