LAKESIDE SERENITY PSYCHIATRY, LLC
NPI 1366308785
Psychiatry & Neurology - Psychiatry in Portland, OR

Q: What is Lakeside Serenity Psychiatry, LLC's NPI number?

The NPI number for Lakeside Serenity Psychiatry, LLC is 1366308785. It was assigned to this organization in the NPPES registry on December 30, 2025.

Q: What is Lakeside Serenity Psychiatry, LLC's specialty?

The primary specialty registered for this NPI is Psychiatry & Neurology, specializing in Psychiatry, with taxonomy code 2084P0800X.

Active since December 30, 2025

5441 S.MACCADAN AVE 8160, PORTLAND, OR 97239(917) 265-9614 Get Directions Write a Review

NPPES record last updated: December 30, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

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About Lakeside Serenity Psychiatry, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LAKESIDE SERENITY PSYCHIATRY, LLC (NPI 1366308785) is a healthcare organization registered as a psychiatry in Portland, Oregon and active in the NPI registry since December 2025. The organization lists Dallas Upchurch, Owner, as its authorized official.

NPPES Registry Identity

NPI1366308785

Entity TypeOrganization

Primary Taxonomy2084P0800X

Legal Business NameLAKESIDE SERENITY PSYCHIATRY, LLC

Location Address5441 S.MACCADAN AVE 8160Portland, OR 97239

Mailing Address821 Kendra DrTemple, TX 76502-5878 · (917) 265-9611 · Fax (917) 265-9614

Phone(917) 265-9614

Organization SubpartNo

Authorized OfficialDallas UpchurchOwner · (917) 265-9614

Enumeration DateDecember 30, 2025

NPPES CertifiedDecember 27, 2025

✔ NPI 1366308785 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychiatry & Neurology · PsychiatryAllopathic & Osteopathic Physicians

Taxonomy Code2084P0800X

Definition

A Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, anxiety disorders, substance-related disorders, sexual and gender identity disorders and adjustment disorders. Biologic, psychological, and social components of illnesses are explored and understood in treatment of the whole person. Tools used may include diagnostic laboratory tests, prescribed medications, evaluation and treatment of psychological and interpersonal problems with individuals and families, and intervention for coping with stress, crises, and other problems.

5441 S.MACCADAN AVE 8160, Portland, OR 97239

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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BridgeSpan Health Company, Regence BlueCross BlueShield of Oregon.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Lakeside Serenity Psychiatry, Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Lakeside Serenity Psychiatry, LLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Dallas Upchurch, PMHNP

Nurse Practitioner

NPI 1013551233

1901 VETERANS MEMORIAL DR
Temple, TX 76504

(254) 778-4811

✔ PECOS1,673 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Lakeside Serenity Psychiatry, LLC's NPI number?

The NPI number for Lakeside Serenity Psychiatry, LLC is 1366308785. It was assigned to this organization in the NPPES registry on December 30, 2025.

Where is Lakeside Serenity Psychiatry, LLC located?

Lakeside Serenity Psychiatry, LLC is located at 5441 S.Maccadan Ave 8160, Portland, OR 97239. The listed phone number is (917) 265-9614.

What is Lakeside Serenity Psychiatry, LLC's specialty?

The primary specialty registered for this NPI is Psychiatry & Neurology, specializing in Psychiatry, with taxonomy code 2084P0800X.

Is Lakeside Serenity Psychiatry, LLC enrolled in Medicare?

Yes. Lakeside Serenity Psychiatry, LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Lakeside Serenity Psychiatry, LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to Lakeside Serenity Psychiatry, LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

What insurance does Lakeside Serenity Psychiatry, LLC accept?

Health plans from BridgeSpan Health Company and Regence BlueCross BlueShield of Oregon list Lakeside Serenity Psychiatry, LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Lakeside Serenity Psychiatry, LLC was last updated on December 30, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.