Lydia Anne M Bartholow, PMHNP
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Portland, OR
NPI 1790038271 · NPPES record last updated Mar 9, 2020
Key facts
- NPI
- 1790038271
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 201250177NP (OR)
- Practice address
- 1027 E Burnside St
Portland, OR 97214-1328 - Phone
- (503) 239-8400
- NPI assigned
- Oct 20, 2012
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 8
Hospital & facility affiliations 4
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2012
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Legacy Emanuel Hospital and Health Center
Practice addresses (Care Compare)
1225 NE 2ND Ave
Portland, OR 97232-2003
Phone (503) 944-8000
Hospital & facility affiliations
- Legacy Emanuel Medical Center
Merit-based Incentive Payment System (MIPS)
- Final score
- 94.62 of 100
- Quality
- 77.21
- Promoting interoperability
- 99.06
- Improvement activities
- 40
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231004002571 | OR | Practitioner - Nurse Practitioner | 2668617580 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 201250177NP | OR | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Coda, Inc. | Current |
Accepting new patients | |
| Legacy Emanuel Hospital & Health Center | Current |
Accepting new patients | |
| Coda, Inc. | Current |
Accepting new patients | |
| Legacy Emanuel Hospital & Health Center | Current |
Accepting new patients | |
| Legacy Emanuel Hospital & Health Center | Current | 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
1027 E Burnside St
Portland, OR 97214
1225 NE 2nd Ave
Portland, OR 97232
Phone (503) 413-5051
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 201250177NP | OR | Yes |
Addresses
Primary practice location
1027 E Burnside St
Portland, OR 97214-1328
Mailing address
1027 E Burnside St
Portland, OR 97214-1328
Phone (971) 202-7774
Other practice location 1
10362 SW McDonald St
Tigard, OR 97224-4863
Phone (503) 239-8400
Other providers in Portland, OR
- Lauren Marie Barthelemy
- Jennelle Rhae Bartholomew
- Kelly Mahara Bartholomew
- Lee Bartholomew
- Samuel Vincent Bartholomew
- Kristin Lynn Bartkowski
- Joy Supreme Bartlett-Ocobock
- Alyssa M Bartlett
- Claire Marie Bartlett
- Isaiah Bartlett
All providers in Portland, OR · Psychiatric/Mental Health Nurse Practitioner in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 9, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.