Individual provider Active NPI

Michelle Lyn Buffie, PHD

  • Psychologist
  • Portland, OR
National Provider Identifier
1689305997
Registry record updated Dec 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
3719 Issued in OR
Practice address
2801 N Gantenbein Ave
Portland, OR 97227-1623
Phone
(503) 276-6500
NPI assigned
Jun 19, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 6, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 3719 OR Primary

Addresses

Primary practice location

2801 N Gantenbein Ave
Portland, OR 97227-1623

Mailing address

2801 N Gantenbein Ave
Portland, OR 97227-1623
Phone (503) 413-2880

Other names 1

  • Michelle Lyn Erhardt Former name

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
I20231108001089 OR Practitioner - Clinical Psychologist 8426405721 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3719ORMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Legacy Emanuel Hospital & Health Center CurrentSince Oct 26, 2023 Accepting new patients
Legacy Emanuel Hospital & Health Center CurrentSince Oct 26, 2023 Accepting new patients
Legacy Emanuel Hospital & Health Center Current Accepting new patients
University Professional Services PastSince Jun 1, 2022 Accepting new patients

Locations

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

1919 NW Lovejoy St
Portland, OR 97209
Phone (503) 415-5600

Organizations & group practices 4

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": "1655596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733443200000",
    "number": "1689305997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2801 N GANTENBEIN AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972271623",
            "telephone_number": "503-413-2880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 N GANTENBEIN AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972271623",
            "telephone_number": "503-276-6500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUFFIE",
        "first_name": "MICHELLE",
        "middle_name": "LYN",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-06-19",
        "last_updated": "2024-12-06",
        "certification_date": "2024-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "OR",
            "license": "3719",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHELLE",
            "last_name": "ERHARDT",
            "middle_name": "LYN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.