NPIMap

Individual provider Active NPI

Erik Supratik Mittra, M.D., PH.D.

  • Nuclear Medicine Physician
  • Portland, OR
National Provider Identifier
1841472537
Registry record updated Jun 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nuclear Medicine PhysicianTaxonomy code 207U00000X
License
MD185627 Issued in OR
Practice address
3181 SW Sam Jackson Park Rd
Portland, OR 97239-3011
Phone
(503) 418-0990
Fax
(503) 494-4982
NPI assigned
Dec 4, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nuclear Medicine Physician 207U00000X A100162 CA
Nuclear Medicine Physician 207U00000X MD185627 OR Primary

Addresses

Primary practice location

3181 SW Sam Jackson Park Rd
Portland, OR 97239-3011

Mailing address

3181 SW Sam Jackson Park Rd
Portland, OR 97239-3011
Phone (503) 418-0990

Other practice location 1

335 SE 8th Ave
Hillsboro, OR 97123-4246
Phone (503) 681-1050

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171208002330 OR Practitioner - Nuclear Medicine 2062562945 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nuclear Medicine
Education
State University of New York at Stony Brook, School of Medicine, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
University Professional ServicesGroup PAC ID 4880760107, 1,683 clinicians

Practice addresses (Care Compare)

3181 SW Sam Jackson Park Rd
Portland, OR 97239-3011
Phone (503) 494-8311

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
99.11 of 100Reported as apm
Quality
84.29
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
80.23 of 100Reported as group
Quality
62.39
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine, Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
A100162CAMDNuclear Medicine Physician
MD185627ORMDNuclear Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University Professional Services Current Accepting new patients
Columbia Lutheran Charities CurrentSince Oct 1, 2020 Accepting new patients
University Professional Services CurrentSince Jan 1, 2018 Accepting new patients
Columbia Lutheran Charities CurrentSince Oct 1, 2020 Accepting new patients
University Professional Services CurrentSince Jan 1, 2018 Accepting new patients
Columbia Lutheran Charities Past Accepting new patients
Columbia Lutheran Charities Past Accepting new patients
University Professional Services Past Accepting new patients
Pacific Imaging Consultants, a Medical Group, Inc. Past Accepting new patients

Locations

2111 Exchange St
Astoria, OR 97103
Phone (503) 325-4321

15700 SW Greystone Ct
Beaverton, OR 97006
Phone (503) 203-1000

1501 NE Medical Center Dr
Bend, OR 97701
Phone (541) 317-4354

335 SE 8th Ave
Hillsboro, OR 97123
Phone (503) 681-1111

3181 SW Sam Jackson Park Rd
Portland, OR 97239
Phone (503) 494-5674

10000 SE Main St
Portland, OR 97216
Phone (503) 251-6961

51377 SW Old Portland Rd
Scappoose, OR 97056
Phone (503) 418-4222

Interoperability endpoints

  • Direct secure messaging: emittra105070@direct.ohsu.edu

Organizations & group practices 9

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": "1196726400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592956800000",
    "number": "1841472537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3181 SW SAM JACKSON PARK RD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972393011",
            "telephone_number": "503-418-0990",
            "fax_number": "503-494-4982"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3181 SW SAM JACKSON PARK RD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972393011",
            "telephone_number": "503-418-0990",
            "fax_number": "503-494-4982"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "335 SE 8th Ave",
            "address_purpose": "LOCATION",
            "city": "Hillsboro",
            "state": "OR",
            "postal_code": "971234246",
            "country_code": "US",
            "telephone_number": "503-681-1050",
            "fax_number": "503-681-1939",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MITTRA",
        "first_name": "ERIK",
        "middle_name": "SUPRATIK",
        "name_prefix": "Dr.",
        "credential": "M.D., PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-12-04",
        "last_updated": "2020-06-24",
        "certification_date": "2020-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207U00000X",
            "taxonomy_group": "",
            "desc": "Nuclear Medicine",
            "state": "CA",
            "license": "A100162",
            "primary": false
        },
        {
            "code": "207U00000X",
            "taxonomy_group": "",
            "desc": "Nuclear Medicine",
            "state": "OR",
            "license": "MD185627",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.