NPIMap

Individual provider Active NPI

Lily A Uzzaman, FNP STUDENT

  • Family Nurse Practitioner
  • Scappoose, OR
National Provider Identifier
1558968594
Registry record updated Jul 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
202212410NP-PP Issued in OR
Practice address
52377 SW Old Portland Rd
Suite C
Scappoose, OR 97056
Phone
(503) 418-4222
NPI assigned
Oct 2, 2020
Last updated
Jul 20, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 20, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 202212410NP-PP OR Primary
Registered Nurse 163W00000X 201240897RN OR

Addresses

Primary practice location

52377 SW Old Portland Rd
Suite C
Scappoose, OR 97056

Mailing address

51377 SW Old Portland Rd Ste C
Scappoose, OR 97056-4023
Phone (503) 418-4222

Other practice location 1

3181 SW Sam Jackson Park Rd
Portland, OR 97239-3011
Phone (503) 494-7551

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
I20221007002524 OR Practitioner - Nurse Practitioner 6204212665 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Oregon Health Sciences University School of Medicine, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

51377 SW Old Portland Rd
Scappoose, OR 97056-4023
Phone (503) 418-4222

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
201240897RNORMDRegistered Nurse
202212410NP-PPORMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
University Professional Services Registered Nurse CurrentSince Aug 12, 2022 Accepting new patients
University Professional Services Current Accepting new patients
Oregon Health & Science University CurrentSince Aug 12, 2022 Accepting new patients
Oregon Health & Science University CurrentSince Aug 12, 2022 Accepting new patients
University Professional Services CurrentSince Aug 12, 2022 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

51377 SW Old Portland Rd
Scappoose, OR 97056
Phone (503) 418-4222

51377 SW Old Portland Rd
Ste C
Scappoose, OR 97056
Phone (503) 418-4222

Interoperability endpoints

  • Direct secure messaging: luzzaman76881@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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1601596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689811200000",
    "number": "1558968594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "51377 SW OLD PORTLAND RD STE C",
            "city": "SCAPPOOSE",
            "state": "OR",
            "postal_code": "970564023",
            "telephone_number": "503-418-4222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "52377 SW OLD PORTLAND RD",
            "address_2": "SUITE C",
            "city": "SCAPPOOSE",
            "state": "OR",
            "postal_code": "97056",
            "telephone_number": "503-418-4222"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3181 SW Sam Jackson Park Rd",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972393011",
            "country_code": "US",
            "telephone_number": "503-494-7551",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "UZZAMAN",
        "first_name": "LILY",
        "middle_name": "A",
        "credential": "FNP STUDENT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-10-02",
        "last_updated": "2023-07-20",
        "certification_date": "2023-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OR",
            "license": "202212410NP-PP",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OR",
            "license": "201240897RN",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Scappoose, OR

Sources for this page

Verify at the official NPI Registry.