JUSTIN ALAN TIDWELL DPM NPI 1710908892

NPI Information

NPI: 1710908892
Provider Name: JUSTIN ALAN TIDWELL, DPM
Classification: Podiatrist - 213ES0103X
Specialization: Foot & Ankle Surgery
Entity Type: Individual
PECOS Registration: Yes
Address: 501 N GRAHAM ST
SUITE 415
PORTLAND, OR
ZIP 97227
Phone: (503) 413-2005

Map and Directions

Get Directions

NPI Details

Justin Alan Tidwell, DPM is a foot and ankle surgery podiatrist in Portland, OR with 23 years of experience. Justin Alan Tidwell, DPM NPI is 1710908892. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

501 N GRAHAM ST
SUITE 415
PORTLAND, OR
ZIP 97227-654
Phone: (503) 413-2005
Fax: (503) 413-3699

The NPI 1710908892 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA).

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

Established patient office or other outpatient visit, 20-29 minutes (HCPCS:99213)
Removal of skin and tissue, 20.0 sq cm or less (HCPCS:11042)
New patient office or other outpatient visit, 30-44 minutes (HCPCS:99203)
Established patient office or other outpatient visit, 30-39 minutes (HCPCS:99214)
Removal of noncancer thickened skin growth, 1 growth (HCPCS:11055)
Removal of skin and tissue, 20.0 sq cm or less (HCPCS:11042)
Established patient office or other outpatient visit, 30-39 minutes (HCPCS:99214)
X-ray of foot, minimum of 3 views (HCPCS:73630)
Removal of fingernails or toenails, 6 or more nails (HCPCS:11721)
X-ray of ankle, minimum of 3 views (HCPCS:73610)
Established patient office or other outpatient visit, 10-19 minutes (HCPCS:99212)
Initial hospital inpatient care per day, typically 50 minutes (HCPCS:99222)
Removal of noncancer thickened skin growth, 2-4 growths (HCPCS:11056)

The enumeration date for this NPI number is 7/22/2006 and was last updated on 7/8/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	213ES0103X	Podiatrist	Foot & Ankle Surgery	PO00000806	WASHINGTON	No
2	213ES0103X	Podiatrist	Foot & Ankle Surgery	DP00373	OREGON	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	V06772	MEDICARE UPIN	NEW MEXICO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

Previous NPI

Next NPI