Individual provider Active NPI

Joshua Tiller-Ormord, PHD

  • Psychologist
  • Portland, OR
National Provider Identifier
1629812250
Registry record updated Sep 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
4047 Issued in OR
Practice address
700 SW Campus Dr
Portland, OR 97239-3107
Phone
(503) 346-0640
NPI assigned
Jun 19, 2024
Last updated
Sep 25, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 4047 OR Primary
Student in an Organized Health Care Education/Training Program 390200000X NU

Addresses

Primary practice location

700 SW Campus Dr
Portland, OR 97239-3107

Mailing address

PO Box 4399
Portland, OR 97208-4399

Other practice location 1

2800 N Vancouver Ave Ste 165
Portland, OR 97227-1644
Phone (503) 413-2902

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251230001601 OR Practitioner - Clinical Psychologist 0345732632 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2024
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1919 NW Lovejoy St
Portland, OR 97209-1503

2850 NW
31St
Portland, OR 97210-1720

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
4047ORMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Legacy Emanuel Hospital & Health Center CurrentSince Sep 25, 2025 Accepting new patients
Legacy Emanuel Hospital & Health Center CurrentSince Sep 25, 2025 Accepting new patients
Legacy Emanuel Hospital & Health Center Current Accepting new patients

Locations

2800 N Vancouver Ave
Ste 165
Portland, OR 97227
Phone (503) 413-2902

2801 N Gantenbein Ave
Portland, OR 97227
Phone (503) 413-2200

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1718755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758758400000",
    "number": "1629812250",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4399",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972084399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 SW CAMPUS DR",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972393107",
            "telephone_number": "503-346-0640"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2800 N Vancouver Ave Ste 165",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972271644",
            "country_code": "US",
            "telephone_number": "503-413-2902",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TILLER-ORMORD",
        "first_name": "JOSHUA",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-06-19",
        "last_updated": "2025-09-25",
        "certification_date": "2025-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "OR",
            "license": "4047",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.