Stephen John Mannino, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

MD157027 Issued in OR

Practice address

10215 SW Hall Blvd
Tigard, OR 97223-8809

Phone

(503) 245-2415

Fax

(503) 244-5963

NPI assigned

Jan 19, 2006

Last updated

Jun 27, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Dermatology

Education

Louisiana State University School of Medicine in New Orleans, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mountain West Derm - Blackhart PLLCGroup PAC ID 1153609813, 103 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ohsu Hospital and Clinics Hospital, Portland, OR, CCN 380009

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Mountain West Derm - Blackhart PLLC

  dba Bend Dermatology Clinic

  • Dermatology Physician
  • Bend, OR
  • NPI 1447764741
  Medicare reassignment Care Compare group NPD
• Portland Clinic

  • Internal Medicine Physician
  • Portland, OR
  • NPI 1558379099

  Dermatology

  Medicare reassignment NPD
• Mountain West Derm-Blackhart, PLLC

  • Dermatology Physician
  • Tigard, OR
  • NPI 1316656994
  NPD
• Portland Clinic

  dba Roger E. Alberty, M.D. Surgical Center

  • Ambulatory Surgical Clinic/Center
  • Tigard, OR
  • NPI 1508040486
  NPD
• The Portland Clinic Laboratory

  • Clinical Medical Laboratory
  • Portland, OR
  • NPI 1053448795
  NPD
• Dermatology Associates,P.C.

  • Specialist
  • Tigard, OR
  • NPI 1851442461
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Oregon Health & Science University

  • General Acute Care Hospital
  • Portland, OR
  • NPI 1609824010
  Care Compare affiliation

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

{
    "created_epoch": "1137628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750982400000",
    "number": "1679553218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10215 SW HALL BLVD",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972238809",
            "telephone_number": "503-245-2415",
            "fax_number": "503-244-5963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10215 SW HALL BLVD",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972238809",
            "telephone_number": "503-245-2415",
            "fax_number": "503-244-5963"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4004 Kruse Way Pl Ste 220",
            "address_purpose": "LOCATION",
            "city": "Lake Oswego",
            "state": "OR",
            "postal_code": "970352449",
            "country_code": "US",
            "telephone_number": "503-245-2415",
            "fax_number": "503-244-5963",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MANNINO",
        "first_name": "STEPHEN",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-19",
        "last_updated": "2025-06-27",
        "certification_date": "2025-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "OR",
            "license": "MD157027",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Araceli Mandujano
• Donald Lee Manghelli, MSW
• Daniel Keith Mangum, DO
• Hailey Rianna Manning-Henseler
• Ruth Manning
• Jose Manriquez, CRM
• Audrey Mansfield
• Tess Ivie Manso
• Steven Douglas Manthe
• Arin Mara

• Dermatology Physician in Tigard, OR
• Providers in Tigard, OR by specialty
• Dermatology Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2025; 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.

Verify at the official NPI Registry.