Active NPI
Mary Chakhtoura
- Clinical Social Worker
- Portland, OR
National Provider Identifier
1679212427
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- L17969
- Practice address
- 3500 NE Martin Luther King Jr Blvd Ste 200
Portland, OR 97212-2093 - Phone
- (503) 327-8205
- NPI assigned
- May 31, 2022
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | L17969 | OR | Primary |
Addresses
Primary practice location
3500 NE Martin Luther King Jr Blvd Ste 200
Portland, OR 97212-2093
Mailing address
2039 E Burnside St
Portland, OR 97214-1649
Phone (206) 397-6815
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 2023
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
4800 N Scottsdale Rd
Suite 2500
Scottsdale, AZ 85251-7630
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L17969 | OR | MD | Clinical Social Worker |
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.
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- Tacoma, WA
- NPI 1912008178
OR
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1653955200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1778630400000",
"number": "1679212427",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2039 E BURNSIDE ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972141649",
"telephone_number": "206-397-6815"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3500 NE MARTIN LUTHER KING JR BLVD STE 200",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972122093",
"telephone_number": "503-327-8205"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHAKHTOURA",
"first_name": "MARY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-05-31",
"last_updated": "2026-05-13",
"certification_date": "2026-05-13",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "OR",
"license": "L17969",
"primary": true
}
],
"identifiers": [],
"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 May 13, 2026; 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.