NPIMap

Individual provider Active NPI

Michael T Lavelle Jr., MD

  • Urology Physician
  • Bend, OR
National Provider Identifier
1881635779
Registry record updated Jan 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
MD25547 Issued in OR
Practice address
2200 NE Neff Rd
Bend, OR 97701-4283
Phone
(541) 548-7761
Fax
(541) 526-6554
NPI assigned
Jun 9, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 2, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X MD25547 OR Primary

Addresses

Primary practice location

2200 NE Neff Rd
Bend, OR 97701-4283

Mailing address

PO Box 6095
Bend, OR 97708-6095
Phone (541) 706-5922

Other practice location 1

2230 NW Pettygrove
Suite 210
Portland, OR 97210
Phone (503) 223-6223

Other practice location 2

1247 NE Medical Center Dr
Bend, OR 97701
Phone (541) 322-5753

Other identifiers 1

IdentifierTypeStateIssuer
277995MedicaidOR

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mlavelle95288@secure.stcharleshealthcare.org

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
I20050520000967 OR Practitioner - Urology 7113968934 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Loyola University of Chicago, Stritch School of Medicine, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
St Charles Health System IncGroup PAC ID 8729111513, 379 clinicians

Practice addresses (Care Compare)

2200 NE Neff Rd
Bend, OR 97701-4283
Phone (541) 382-4321

Hospital & facility affiliations

  • St Charles Medical Center - Bend Hospital, Bend, OR, CCN 380047
  • St Charles Medical Center Prineville Hospital, Prineville, OR, CCN 381313
  • St Charles Madras Hospital, Madras, OR, CCN 381324
  • Harney District Hospital Hospital, Burns, OR, CCN 381307
  • Sky Lakes Medical Center Hospital, Klamath Falls, OR, CCN 380050

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
St. Charles Health System, Inc. CurrentSince Nov 6, 2023 Accepting new patients
St. Charles Health System, Inc. CurrentSince Nov 6, 2023 Accepting new patients
St. Charles Health System, Inc. Past Accepting new patients

Locations

29358 Network Pl
Chicago, IL 60673

2200 NE Neff Rd
Bend, OR 97701
Phone (541) 322-2323

211 NW Larch Ave
Redmond, OR 97756
Phone (541) 548-2164

Interoperability endpoints

  • Direct secure messaging: mlavelle95288@secure.stcharleshealthcare.org

Organizations & group practices 3

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 8

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": "1149811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704153600000",
    "number": "1881635779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6095",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977086095",
            "telephone_number": "541-706-5922",
            "fax_number": "541-706-6869"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 NE NEFF RD",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977014283",
            "telephone_number": "541-548-7761",
            "fax_number": "541-526-6554"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2230 NW Pettygrove",
            "address_2": "Suite 210",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "97210",
            "country_code": "US",
            "telephone_number": "503-223-6223",
            "fax_number": "503-223-3665",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1247 NE Medical Center Dr",
            "address_purpose": "LOCATION",
            "city": "Bend",
            "state": "OR",
            "postal_code": "97701",
            "country_code": "US",
            "telephone_number": "541-322-5753",
            "fax_number": "541-278-8377",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LAVELLE",
        "first_name": "MICHAEL",
        "middle_name": "T",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-09",
        "last_updated": "2024-01-02",
        "certification_date": "2024-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "OR",
            "license": "MD25547",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "277995",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mlavelle95288@secure.stcharleshealthcare.org",
            "affiliation": "N",
            "address_1": "2200 NE Neff Rd",
            "city": "Bend",
            "state": "OR",
            "country_code": "US",
            "postal_code": "977014283",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Bend, OR

Sources for this page

Verify at the official NPI Registry.