Samantha Ellefson, RD LD CSP

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

LD-D-10159207 Issued in OR

Practice address

3181 S.W. Sam Jackson Park Rd
Mail Code: Uhs 18
Portland, OR 97239-3098

Phone

(503) 418-5257

Fax

(503) 418-5317

NPI assigned

Mar 30, 2013

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1364601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1386806400000",
    "number": "1902149750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3181 SW SAM JACKSON PARK RD",
            "address_2": "MAIL CODE: UHS 18",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972393011",
            "telephone_number": "503-418-5257",
            "fax_number": "503-418-5317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3181 S.W. SAM JACKSON PARK RD",
            "address_2": "MAIL CODE: UHS 18",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972393098",
            "telephone_number": "503-418-5257",
            "fax_number": "503-418-5317"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLEFSON",
        "first_name": "SAMANTHA",
        "credential": "RD LD CSP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-03-30",
        "last_updated": "2013-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "GA",
            "license": "LD003133",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "OR",
            "license": "LD-D-10159207",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly Elkins, MS CF-SLP
• Lillie Elkins
• Elkjer Dental Clinic, P.C.
• Steven R Elkjer, DMD
• Ravikiran Ellandula, M.D.
• Ellen Michaelson MD PC
• Miles Steven Ellenby, MD
• Julie Ellender
• Tonya Marie Ellenson
• Sarah Alder Ellenwood

• Registered Dietitian in Portland, OR
• Providers in Portland, OR by specialty
• Registered Dietitian in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2013; 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.