Lifestyle Medicine Group – Registered Dietitian, NPI 1275604399
Registered Dietitian
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Lifestyle Medicine Group
6542 SE LAKE RD STE 202C
MILWAUKIE, OR 972222244
Phone: (503) 652-5070
Fax: (800) 957-1067
Type: Location
1463, Southwest 20th Court, Gresham, Metro, Multnomah County, Oregon, 97080, United States
GRESHAM, OR 970809662
Phone: (503) 652-5070
Type: Mailing
Metabolic Research Center, 8800, Southeast Sunnyside Road, Harmony, Oatfield, Metro, Clackamas County, Oregon, 97015, United States
SUITE 224-SOUTH
CLACKAMAS, OR 970155738
Phone: (503) 652-5070
Fax: (800) 957-1067
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2018-08-16
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2024-07-31 (677 days ago).
Enrollment records
4
Earliest due date
2024-07-31
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20110331000058 | O | Clinic/Group Practice | OR | TBD |
| O20180208001188 | O | Clinic/Group Practice | WA | 2024-07-31 |
| O20180426001546 | O | In-Person Mdpp Supplier | OR | TBD |
| O20180816003156 | O | In-Person Mdpp Supplier | WA | TBD |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 97222)
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