Active NPI
Angelo Mario De Mattos, MD
- Nephrology Physician
- Portland, OR
National Provider Identifier
1619984812
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nephrology Physician
- License
- MD192424
- Practice address
- 3181 SW Sam Jackson Park Rd
Portland, OR 97239-3011 - Phone
- (503) 494-3442
- Fax
- (503) 494-5330
- NPI assigned
- Aug 1, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Nephrology Physician | 207RN0300X | MD192424 | OR | Primary |
Addresses
Primary practice location
3181 SW Sam Jackson Park Rd
Portland, OR 97239-3011
Mailing address
3181 SW Sam Jackson Park Rd
Portland, OR 97239-3011
Phone (503) 494-3442
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 009981565 | Medicaid | AL | |
| 04808231 | Other | MS | MISSISSIPPI MEDCAID |
| 051524242 | Other | AL | BLUE CROSS |
| 009981555 | Medicaid | AL | |
| 051524243 | Other | AL | BLUE CROSS |
| P00159465 | Other | AL | RAILROAD MEDICARE |
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: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20191021003544 | OR | Practitioner - Nephrology | 4981671682 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Nephrology
- Education
- Other, 1985
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- University Professional Services
Practice addresses (Care Compare)
3181 SW Sam Jackson Park Rd
Portland, OR 97239-3011
Phone (503) 494-8311
Hospital & facility affiliations
- Ohsu Hospital and Clinics
- Asante Rogue Regional Medical Center
- Salem Hospital
- Columbia Memorial Hospital
- Good Samaritan Regional Medical Center
Merit-based Incentive Payment System (MIPS)
- Final score
- 99.11 of 100
- Quality
- 84.29
- Promoting interoperability
- 100
- Improvement activities
- 40
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 100800 | CA | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| University Professional Services | Current | Accepting new patients |
Locations
15700 SW Greystone Ct
Beaverton, OR 97006
Phone (503) 203-1000
901 E 18th Ave
Eugene, OR 97403
Phone (541) 346-3575
2825 E Barnett Rd
Medford, OR 97504
Phone (541) 282-6770
3181 SW Sam Jackson Park Rd
Portland, OR 97239
Phone (503) 494-5674
Interoperability endpoints
- ademattos119526@direct.ohsu.edu
Organizations & group practices 4
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.
-
- Pharmacy
- Beaverton, OR
- NPI 1073054714
-
- Clinic/Center
- Vancouver, WA
- NPI 1881848307
-
- Multi-Specialty Clinic/Center
- Portland, OR
- NPI 1073767588
Hospital & facility affiliations 29
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Endocrinology, Diabetes & Metabolism Physician
- Corvallis, OR
- NPI 1134552003
Hospital
-
- Obstetrics & Gynecology Physician
- Corvallis, OR
- NPI 1275882102
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154390400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1572912000000",
"number": "1619984812",
"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": "972393011",
"telephone_number": "503-494-3442",
"fax_number": "503-494-5330"
},
{
"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": "972393011",
"telephone_number": "503-494-3442",
"fax_number": "503-494-5330"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DE MATTOS",
"first_name": "ANGELO",
"middle_name": "MARIO",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-01",
"last_updated": "2019-11-05",
"status": "A"
},
"taxonomies": [
{
"code": "207RN0300X",
"taxonomy_group": "",
"desc": "Internal Medicine, Nephrology",
"state": "OR",
"license": "MD192424",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "009981565",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MISSISSIPPI MEDCAID",
"identifier": "04808231",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "051524242",
"state": "AL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "009981555",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "051524243",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00159465",
"state": "AL"
}
],
"endpoints": [],
"other_names": []
}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 Nov 5, 2019; 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.