Active NPI
Mischelle McMillan, MD
- Internal Medicine Physician
- Gresham, OR
National Provider Identifier
1851461990
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- MD19769
- Practice address
- 24988 SE Stark St
#220
Gresham, OR 97030-8322 - Phone
- (503) 674-1580
- Fax
- (503) 674-1581
- NPI assigned
- Nov 8, 2006
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | MD19769 | OR | Primary |
Addresses
Primary practice location
24988 SE Stark St
#220
Gresham, OR 97030-8322
Mailing address
24988 SE Stark St.
#220
Gresham, OR 97030
Phone (503) 674-1580
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 081682 | Medicaid | OR |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD19769 | OR | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Legacy Mount Hood Medical Center | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Clinic/Center
- Gresham, OR
- NPI 1386919132
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162944000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1489708800000",
"number": "1851461990",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24988 SE STARK ST.",
"address_2": "#220",
"city": "GRESHAM",
"state": "OR",
"postal_code": "97030",
"telephone_number": "503-674-1580",
"fax_number": "503-674-1581"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24988 SE STARK ST",
"address_2": "#220",
"city": "GRESHAM",
"state": "OR",
"postal_code": "970308322",
"telephone_number": "503-674-1580",
"fax_number": "503-674-1581"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCMILLAN",
"first_name": "MISCHELLE",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-08",
"last_updated": "2017-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "OR",
"license": "MD19769",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "081682",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Gresham, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.