Individual provider Active NPI

Mindy Thanh Minh Ta, OD

  • Optometrist
  • Milwaukie, OR
National Provider Identifier
1942282926
Registry record updated Feb 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3140T Issued in OR
Practice address
11086 SE Oak St
Milwaukie, OR 97222-6692
Phone
(503) 656-4221
Fax
(503) 656-4249
NPI assigned
Nov 16, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 3140T OR Primary

Addresses

Primary practice location

11086 SE Oak St
Milwaukie, OR 97222-6692

Mailing address

PO Box 22009
Portland, OR 97269-2009
Phone (503) 558-7372

Other identifiers 1

IdentifierTypeStateIssuer
213509MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050908001078 OR Practitioner - Optometry 2163454281 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
New England College of Optometry, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Eye Health Northwest PCGroup PAC ID 9234039926, 72 clinicians

Practice addresses (Care Compare)

11086 SE Oak St
Milwaukie, OR 97222-6692
Phone (503) 656-4221

Merit-based Incentive Payment System (MIPS)

Final score
88.74 of 100Reported as group
Quality
85.23
Promoting interoperability
100
Improvement activities
40
Cost
77.25

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3140TORMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Eye Health Northwest P.C. Optometrist CurrentSince Aug 2, 2005 Accepting new patients
Eye Health Northwest, PC CurrentSince Aug 2, 2005 Accepting new patients

Locations

11086 SE Oak St
Portland, OR 97222
Phone (503) 557-2020

Interoperability endpoints

  • Direct secure messaging: mindy.ta@direct.ehnpc.nextgenshare.com

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1132099200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613779200000",
    "number": "1942282926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22009",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972692009",
            "telephone_number": "503-558-7372",
            "fax_number": "503-344-5140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11086 SE OAK ST",
            "city": "MILWAUKIE",
            "state": "OR",
            "postal_code": "972226692",
            "telephone_number": "503-656-4221",
            "fax_number": "503-656-4249"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TA",
        "first_name": "MINDY",
        "middle_name": "THANH MINH",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-16",
        "last_updated": "2021-02-20",
        "certification_date": "2021-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "3140T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "213509",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukie, OR

Sources for this page

Verify at the official NPI Registry.