Northwest Extremity Specialists LLC

Primary specialty

Podiatric Clinic/CenterTaxonomy code 261QP1100X

Legal business name

NORTHWEST EXTREMITY SPECIALISTS LLC

Practice address

2222 NW Lovejoy St Ste 510
Portland, OR 97210-5103

Phone

(503) 221-1581

Fax

(503) 221-1582

NPI assigned

Mar 11, 2021

Last updated

Mar 11, 2021By the provider in NPPES

Organization subpart

Yes

Parent organization

NORTHWEST EXTREMITY SPECIALISTS LLCAs reported in NPPES

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

Authorized official

Name

Thomas Charles Melillo, DPMNPI 1619085479

Title

Owner

Phone

(503) 245-2420

Specialties & licenses 1

Addresses

Other names 1

• NES Portland NW Lovejoy Other name

Part of

Northwest Extremity Specialists LLC

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Thomas Charles Melillo, DPM

  • Foot & Ankle Surgery Podiatrist
  • Portland, OR
  • NPI 1619085479
  Authorized official Same address or phone

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

{
    "created_epoch": "1615420800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615420800000",
    "number": "1659956589",
    "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": "2222 NW LOVEJOY ST STE 510",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972105103",
            "telephone_number": "503-221-1581",
            "fax_number": "503-221-1582"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST EXTREMITY SPECIALISTS LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTHWEST EXTREMITY SPECIALISTS LLC",
        "enumeration_date": "2021-03-11",
        "last_updated": "2021-03-11",
        "certification_date": "2021-03-11",
        "status": "A",
        "authorized_official_last_name": "MELILLO",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "CHARLES",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-245-2420",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "261QP1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Podiatric",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NES Portland NW Lovejoy",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Podiatric Clinic/Center in Portland, OR
• Providers in Portland, OR by specialty
• Podiatric Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.