Laura Mellick, MD

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

MD17993 Issued in OR

Practice address

25 NW 23Rd PL
Suite 11
Portland, OR 97210-5580

Phone

(503) 305-6262

Fax

(503) 305-6078

NPI assigned

Apr 10, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: laura.mellick.1@10272.direct.athenahealth.com

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.

• Cep America LLC

  • Emergency Medicine Physician
  • Roseburg, OR
  • NPI 1780647719
  NPD (past)
• Uptown Providers PC

  • General Practice Physician
  • Portland, OR
  • NPI 1144598293
  NPD (past)
• Cep America LLC

  • Emergency Medicine Physician
  • Edmonds, WA
  • NPI 1447484274
  NPD (past)

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

{
    "created_epoch": "1144627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1346889600000",
    "number": "1851354872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5275",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972085275",
            "telephone_number": "888-828-3196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 NW 23RD PL",
            "address_2": "SUITE 11",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972105580",
            "telephone_number": "503-305-6262",
            "fax_number": "503-305-6078"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MELLICK",
        "first_name": "LAURA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-10",
        "last_updated": "2012-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OR",
            "license": "MD17993",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "OR",
            "license": "MD17993",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WA L & I",
            "identifier": "208975",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "057252",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BC/BS",
            "identifier": "858543007",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8182214",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melissa Miesen, PC
• Melissa Yeary LPC, LLC
• Carole Anne Melkonian, LAC, RN
• Marie Mellberg, MS, CRC, LPC
• Assefash Melles, MS
• Michael James Mellick
• Randall Mello, PHARMD
• Margret Lee Mellon, LMT
• Michael D. Mellum, D.M.D.
• Nicholas Ryan Mellum, DMD

• General Practice Physician in Portland, OR
• Providers in Portland, OR by specialty
• General Practice Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.