Individual provider Active NPI

Melinda Sue Nicholes, DPM

  • Podiatrist
  • Portland, OR
National Provider Identifier
1699330803
Registry record updated Jan 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
DP211498 Issued in OR
Practice address
9115 SW Oleson Rd Ste 205
Portland, OR 97223-6877
Phone
(503) 245-2420
Fax
(503) 245-2445
NPI assigned
May 2, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 2, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery Podiatrist 213ES0103X DP211498 OR
Podiatrist 213E00000X DP211498 OR Primary

Addresses

Primary practice location

9115 SW Oleson Rd Ste 205
Portland, OR 97223-6877

Mailing address

9115 SW Oleson Rd Ste 205
Portland, OR 97223-6877
Phone (503) 245-2420

Other practice location 1

12303 DePaul Drive
Bridgeton, MO 63044
Phone (314) 344-6000

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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220831000575 OR Practitioner - Podiatry 2668856238 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
College of Podiatric Med and Surgery, Des Moines University, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northwest Extremity Specialists LLCGroup PAC ID 3577881747, 21 clinicians

Practice addresses (Care Compare)

12400 NW Cornell Rd
Suite 201
Portland, OR 97229-5689
Phone (503) 643-1737

Hospital & facility affiliations

  • Providence Willamette Falls Medical Center Hospital, Oregon City, OR, CCN 380038

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue25
Removal of nail tissue133
Removal or shaving of skin growth79

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DP211498ORMDFoot & Ankle Surgery Podiatrist

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1556755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735776000000",
    "number": "1699330803",
    "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": "9115 SW OLESON RD STE 205",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972236877",
            "telephone_number": "503-245-2420",
            "fax_number": "503-245-2445"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12303 DePaul Drive",
            "address_purpose": "LOCATION",
            "city": "Bridgeton",
            "state": "MO",
            "postal_code": "63044",
            "country_code": "US",
            "telephone_number": "314-344-6000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NICHOLES",
        "first_name": "MELINDA",
        "middle_name": "SUE",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-02",
        "last_updated": "2025-01-02",
        "certification_date": "2025-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "OR",
            "license": "DP211498",
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "OR",
            "license": "DP211498",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.