Active NPI
Ellen Kyte Mayock, MD
- Internal Medicine Physician
- Lake Oswego, OR
National Provider Identifier
1619930237
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- MD19822
- Practice address
- 18010 McEwan Rd
Lake Oswego, OR 97035-7868 - Phone
- (503) 525-7500
- Fax
- (503) 525-7501
- NPI assigned
- Apr 7, 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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | MD19822 | OR | Primary |
Addresses
Primary practice location
18010 McEwan Rd
Lake Oswego, OR 97035-7868
Mailing address
18010 McEwan Rd
Lake Oswego, OR 97035-7868
Phone (503) 525-7500
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD19822 | OR | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Legacy Meridian Park Hospital | Past | Accepting new patients |
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.
-
- Hospitalist Physician
- Tualatin, OR
- NPI 1023305034
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144368000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1298592000000",
"number": "1619930237",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18010 MCEWAN RD",
"city": "LAKE OSWEGO",
"state": "OR",
"postal_code": "970357868",
"telephone_number": "503-525-7500",
"fax_number": "503-525-7501"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18010 MCEWAN RD",
"city": "LAKE OSWEGO",
"state": "OR",
"postal_code": "970357868",
"telephone_number": "503-525-7500",
"fax_number": "503-525-7501"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAYOCK",
"first_name": "ELLEN",
"middle_name": "KYTE",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-04-07",
"last_updated": "2011-02-25",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "OR",
"license": "MD19822",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Oswego, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.