Active NPI
Tate Marie Correll, DO
- Pediatrics Physician
- Portland, OR
National Provider Identifier
1417416579
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- DO210186
- Practice address
- 3181 SW Sam Jackson Park Rd
Portland, OR 97239-3098 - Phone
- (503) 494-8211
- NPI assigned
- Mar 18, 2019
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Pediatrics Physician | 208000000X | DO210186 | OR | Primary |
Addresses
Primary practice location
3181 SW Sam Jackson Park Rd
Portland, OR 97239-3098
Mailing address
3181 SW Sam Jackson Park Rd
Portland, OR 97239-3098
Phone (503) 494-8211
Other names 1
- Tate Marie Van Winkle
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 Osteopathy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Latouche Pediatrics | Pediatrics | Past | Accepting new patients |
| Providence Health & Services Washington | Past | Accepting new patients |
Interoperability endpoints
- tcorrell109411@direct.ohsu.edu
- tatecorrell@latouchepe.allscriptsdirect.net
Organizations & group practices 2
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
- Anchorage, AK
- NPI 1457328601
-
- General Acute Care Hospital
- Anchorage, AK
- NPI 1053363119
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1552867200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1654041600000",
"number": "1417416579",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3181 SW SAM JACKSON PARK RD",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972393098",
"telephone_number": "503-494-8211"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3181 SW SAM JACKSON PARK RD",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972393098",
"telephone_number": "503-494-8211"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CORRELL",
"first_name": "TATE",
"middle_name": "MARIE",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-03-18",
"last_updated": "2022-06-01",
"certification_date": "2022-06-01",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "OR",
"license": "DO210186",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "TATE",
"last_name": "VAN WINKLE",
"middle_name": "MARIE",
"code": "1",
"type": "Former Name"
}
]
}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 Jun 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.