Active NPI
Misty Lynn Rivoli, LMT
- Specialist
- Portland, OR
National Provider Identifier
1841403466
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 5898
- Practice address
- 6124 SE Milwaukie Ave
Portland, OR 97202-5347 - Phone
- (503) 318-4870
- Fax
- (503) 284-8781
- NPI assigned
- May 8, 2007
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Specialist | 174400000X | 5898 | OR | Primary |
Addresses
Primary practice location
6124 SE Milwaukie Ave
Portland, OR 97202-5347
Mailing address
1620 NE Going St
Portland, OR 97211-5054
Phone (503) 318-4870
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5898 | OR | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178582400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1841403466",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1620 NE GOING ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972115054",
"telephone_number": "503-318-4870",
"fax_number": "503-284-8781"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6124 SE MILWAUKIE AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972025347",
"telephone_number": "503-318-4870",
"fax_number": "503-284-8781"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RIVOLI",
"first_name": "MISTY",
"middle_name": "LYNN",
"name_prefix": "Mrs.",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "OR",
"license": "5898",
"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 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.