Individual provider Active NPI

Thomas Charles Melillo, DPM

  • Foot & Ankle Surgery Podiatrist
  • Portland, OR
National Provider Identifier
1619085479
Registry record updated Jan 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
DP00334 Issued in OR
Practice address
9115 SW Oleson Rd Ste 205
Portland, OR 97223-6877
Phone
(503) 245-2420
NPI assigned
Aug 29, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery Podiatrist 213ES0103X DP00334 OR Primary

Addresses

Primary practice location

9115 SW Oleson Rd Ste 205
Portland, OR 97223-6877

Mailing address

9115 SW Oleson Rd Ste 205
Portland, OR 97223-6877
Phone (503) 245-2420

Other identifiers 1

IdentifierTypeStateIssuer
228835MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040414000811 OR Practitioner - Podiatry 8729071741 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Kent State University College of Podiatric Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northwest Extremity Specialists LLCGroup PAC ID 3577881747, 21 clinicians

Practice addresses (Care Compare)

9115 SW Oleson Rd
Suite 205
Portland, OR 97223-6877
Phone (503) 245-2420

Hospital & facility affiliations

  • Providence St Vincent Medical Center Hospital, Portland, OR, CCN 380004

Merit-based Incentive Payment System (MIPS)

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

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue65
Removal of nail tissue202
Removal or shaving of skin growth179

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Northwest Extremity Specialists LLC CurrentSince Jun 1, 2015 Accepting new patients
Northwest Extremity Specialists LLC CurrentSince Oct 1, 2013 Accepting new patients

Locations

16144 SE Happy Vly Twn Center Dr
Ste 101
Happy Valley, OR 97086
Phone (503) 353-1272

201 N Washington St
Newberg, OR 97132
Phone (503) 538-0800

6542 SE Lake Rd
Ste 102
Portland, OR 97222
Phone (503) 659-6686

1515 NW 18th Ave
Ste 300
Portland, OR 97209

16770 SW Edy Rd
Ste 216
Sherwood, OR 97140
Phone (503) 297-3778

9900 SW Hall Blvd
Ste 100
Tigard, OR 97223

9115 SW Oleson Rd
Ste 205
Tigard, OR 97223
Phone (503) 243-5710

9115 SW Olson Rd
Tigard, OR 97223
Phone (971) 236-0915

18040 SW Lower Boones Ferry Rd
Ste 207
Tigard, OR 97224
Phone (503) 216-5380

5493 Amy St
West Linn, OR 97068
Phone (503) 710-9839

Interoperability endpoints

  • Direct secure messaging: thomas.melillo@pfac.eclinicaldirectplus.com

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609891200000",
    "number": "1619085479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9115 SW OLESON RD STE 205",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972236877",
            "telephone_number": "503-245-2420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9115 SW OLESON RD STE 205",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972236877",
            "telephone_number": "503-245-2420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MELILLO",
        "first_name": "THOMAS",
        "middle_name": "CHARLES",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-29",
        "last_updated": "2021-01-06",
        "certification_date": "2021-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "OR",
            "license": "DP00334",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "228835",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.