Individual provider Active NPI

Mai P Leopold, DO

  • Family Medicine Physician
  • Clackamas, OR
National Provider Identifier
1649234915
Registry record updated Aug 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
DO12247 Issued in OR
Practice address
10151 SE Sunnyside Rd Ste 100
Clackamas, OR 97015-5705
Phone
(503) 659-0880
Fax
(503) 513-7425
NPI assigned
Apr 13, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X DO12247 OR Primary

Addresses

Primary practice location

10151 SE Sunnyside Rd Ste 100
Clackamas, OR 97015-5705

Mailing address

PO Box 92900
Portland, OR 97292-0900
Phone (503) 659-0880

Other identifiers 2

IdentifierTypeStateIssuer
060467MedicaidOR
130904OtherWAWA LABOR & INDUSTRIES

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101029000174 OR Practitioner - Family Practice 7911191473

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Portland Adventist Medical Center Family Medicine PastSince Dec 6, 2022 Accepting new patients
Portland Adventist Medical Center Family Medicine Past Accepting new patients

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.

NPI Registry JSON

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

{
    "created_epoch": "1144886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597795200000",
    "number": "1649234915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 92900",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972920900",
            "telephone_number": "503-659-0880",
            "fax_number": "503-513-7425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10151 SE SUNNYSIDE RD STE 100",
            "city": "CLACKAMAS",
            "state": "OR",
            "postal_code": "970155705",
            "telephone_number": "503-659-0880",
            "fax_number": "503-513-7425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEOPOLD",
        "first_name": "MAI",
        "middle_name": "P",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-13",
        "last_updated": "2020-08-19",
        "certification_date": "2020-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "DO12247",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060467",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WA LABOR & INDUSTRIES",
            "identifier": "130904",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clackamas, OR

Sources for this page

Verify at the official NPI Registry.