Active NPI
David Joseph Lilly, PH.D.
- Audiologist
- Portland, OR
National Provider Identifier
1710141262
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Audiologist
- License
- 20574
- Practice address
- 685 NW Melinda Ave
Portland, OR 97210-3126 - Phone
- (503) 224-8073
- NPI assigned
- Jul 14, 2008
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Audiologist | 231H00000X | 20574 | OR | Primary |
Addresses
Primary practice location
685 NW Melinda Ave
Portland, OR 97210-3126
Mailing address
685 NW Melinda Ave
Portland, OR 97210-3126
Phone (503) 224-8073
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20574 | OR | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1215993600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1215993600000",
"number": "1710141262",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "685 NW MELINDA AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972103126",
"telephone_number": "503-224-8073"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "685 NW MELINDA AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972103126",
"telephone_number": "503-224-8073"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LILLY",
"first_name": "DAVID",
"middle_name": "JOSEPH",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-07-14",
"last_updated": "2008-07-14",
"status": "A"
},
"taxonomies": [
{
"code": "231H00000X",
"taxonomy_group": "",
"desc": "Audiologist",
"state": "OR",
"license": "20574",
"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 Jul 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.