Christopher Blaine Mikulic, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

3693 Issued in OR

Practice address

4004 Kruse Way PL Ste 300
Lake Oswego, OR 97035-2479

Phone

(503) 216-1500

NPI assigned

May 7, 2018

Last updated

Feb 2, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

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 Psychologist

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Providence Health and Services OregonGroup PAC ID 0648183608, 1,423 clinicians

Providence Health and Services OregonGroup PAC ID 1557260106, 97 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Providence Health & Services Oregon

  dba Providence Medical Group

  • General Practice Physician
  • Lake Oswego, OR
  • NPI 1023488343
  Medicare reassignment Care Compare group NPD
• Providence Health & Services Oregon

  dba Providence Seaside Hospital

  • Critical Access Hospital
  • Seaside, OR
  • NPI 1578500492
  Medicare reassignment Care Compare group NPD
• Providence Health & Services Oregon

  dba Providence Milwaukie Hospital

  • General Acute Care Hospital
  • Milwaukie, OR
  • NPI 1366536963
  Medicare reassignment NPD
• Providence Health & Services - Oregon

  dba Providence Medical Group

  • Pediatrics Physician
  • Portland, OR
  • NPI 1033299458
  NPD
• Providence Health & Services Oregon

  dba Providence Milwaukie Hospital

  • Clinical Pathology Physician
  • Milwaukie, OR
  • NPI 1578014239
  NPD
• Providence Health & Services Oregon

  • Psychiatric Hospital Unit
  • Milwaukie, OR
  • NPI 1659751360
  NPD
• Providence Health & Services Oregon

  dba Providence Medical Group

  • Psychiatry Physician
  • Portland, OR
  • NPI 1760177737
  NPD
• Providence Health & Services Oregon

  dba Providence Seaside Hospital - Providence Warrenton Clinic

  • Rural Health Clinic/Center
  • Warrenton, OR
  • NPI 1972039170
  NPD

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

{
    "created_epoch": "1525651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706832000000",
    "number": "1548759418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3158",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083158",
            "telephone_number": "503-215-6494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4004 KRUSE WAY PL STE 300",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970352479",
            "telephone_number": "503-216-1500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIKULIC",
        "first_name": "CHRISTOPHER",
        "middle_name": "BLAINE",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-05-07",
        "last_updated": "2024-02-02",
        "certification_date": "2024-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "OR",
            "license": "3693",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deborah Lynn Mertlich, LCSW
• Cari Mestas
• Mindy Meyers, LMT
• Natalie Mickola, MA, LPC
• Cindy Miguel, M.A.
• Milanovich Chiropractic LLC (Milan Center)
• Michael Pete Milanovich, DC
• Peter J. Milanovich, DC, LPT
• Margot Miles, CHT
• Alison R Miller

• Clinical Psychologist in Lake Oswego, OR
• Providers in Lake Oswego, OR by specialty
• Clinical Psychologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2024; 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.