NPIMap

Organization Active NPI

Northwest Extremity Specialists LLC

  • Podiatric Clinic/Center
  • Portland, OR
National Provider Identifier
1760067698
Registry record updated Mar 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Podiatric Clinic/CenterTaxonomy code 261QP1100X
Legal business name
NORTHWEST EXTREMITY SPECIALISTS LLC
Practice address
5050 NE Hoyt St Ste 411
Portland, OR 97213-2983
Phone
(503) 643-1737
Fax
(503) 643-4926
NPI assigned
Mar 11, 2021
Organization subpart
Yes
Parent organization
NORTHWEST EXTREMITY SPECIALISTS LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 11, 2021

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

Authorized official

Name
Thomas Charles Melillo, DPM
Title
Owner
Phone
(503) 245-2420

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatric Clinic/Center 261QP1100X Primary

Addresses

Primary practice location

5050 NE Hoyt St Ste 411
Portland, OR 97213-2983

Mailing address

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

Other names 1

  • NES Hoyt Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210621002467 OR DME Supplier - Physician - Podiatry 3577881747 Practice locations: Portland, OR

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Northwest Extremity Specialists LLC4 organizations share this tax ID, including this one
Part of
Northwest Extremity Specialists LLC

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1615420800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615420800000",
    "number": "1760067698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9115 SW OLESON RD STE 205",
            "city": "TIGARD",
            "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": "5050 NE HOYT ST STE 411",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972132983",
            "telephone_number": "503-643-1737",
            "fax_number": "503-643-4926"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST EXTREMITY SPECIALISTS LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTHWEST EXTREMITY SPECIALISTS LLC",
        "enumeration_date": "2021-03-11",
        "last_updated": "2021-03-11",
        "certification_date": "2021-03-11",
        "status": "A",
        "authorized_official_last_name": "MELILLO",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "CHARLES",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-245-2420",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "261QP1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Podiatric",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NES Hoyt",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Mar 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.