Individual provider Active NPI

Kayla Mae Eversole, PA-C

  • Physician Assistant
  • Portland, OR
National Provider Identifier
1003420795
Registry record updated Oct 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA221668 Issued in OR
Practice address
1815 SW Marlow Ave Ste 100
Portland, OR 97225-5185
Phone
(503) 935-8100
Fax
(503) 935-8110
NPI assigned
Sep 1, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 14, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA221668 OR Primary
Medical Physician Assistant 363AM0700X 61328609 WA

Addresses

Primary practice location

1815 SW Marlow Ave Ste 100
Portland, OR 97225-5185

Mailing address

541 NE 20TH Ave Ste 225
Portland, OR 97232-2895
Phone (503) 963-2801

Other practice location 1

5920 NE Ray Cir Ste 220
Hillsboro, OR 97124-6313
Phone (503) 935-8100

Other identifiers 1

IdentifierTypeStateIssuer
500847260MedicaidOR

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address cc_otoc_ent_west_front_desk_pool12223135@oc.providencedirect.org The Oregon Clinic PC

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: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241011002654 OR Practitioner - Physician Assistant 8820473796 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Oregon Clinic, PCGroup PAC ID 2860390408, 353 clinicians

Practice addresses (Care Compare)

1815 SW Marlow Ave
Suite 100
Portland, OR 97225-5185
Phone (503) 935-8100

5050 NE Hoyt
Suite 655
Portland, OR 97213-2990
Phone (503) 239-6673

5920 NE Ray Cir
Suite 220
Hillsboro, OR 97124-6313
Phone (503) 935-8100

Hospital & facility affiliations

  • Providence St Vincent Medical Center Hospital, Portland, OR, CCN 380004
  • Providence Portland Medical Center Hospital, Portland, OR, CCN 380061
  • Providence Seaside Hospital Hospital, Seaside, OR, CCN 381303
  • Providence Newberg Medical Center Hospital, Newberg, OR, CCN 380037

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
61328609WAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
The Oregon Clinic, PC CurrentSince Oct 14, 2024 Accepting new patients

Locations

5920 NE Ray Cir
Ste 220
Hillsboro, OR 97124
Phone (503) 690-0707

5050 NE Hoyt St
Ste 655
Portland, OR 97213
Phone (503) 239-6673

9155 SW Barnes Rd
Ste 536
Portland, OR 97225
Phone (503) 935-8100

541 NE 20th Ave
Ste 225
Portland, OR 97232
Phone (503) 963-2801

1815 SW Marlow Ave
Ste 100
Portland, OR 97225
Phone (503) 935-8100

Interoperability endpoints

  • Direct secure messaging: cc_otoc_ent_west_front_desk_pool12223135@oc.providencedirect.org
  • Direct secure messaging: keversole3497470@oc.providencedirect.org

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1598918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760400000000",
    "number": "1003420795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "541 NE 20TH AVE STE 225",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972322895",
            "telephone_number": "503-963-2801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1815 SW MARLOW AVE STE 100",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972255185",
            "telephone_number": "503-935-8100",
            "fax_number": "503-935-8110"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5920 NE Ray Cir Ste 220",
            "address_purpose": "LOCATION",
            "city": "Hillsboro",
            "state": "OR",
            "postal_code": "971246313",
            "country_code": "US",
            "telephone_number": "503-935-8100",
            "fax_number": "503-935-8110",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EVERSOLE",
        "first_name": "KAYLA",
        "middle_name": "MAE",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-09-01",
        "last_updated": "2025-10-14",
        "certification_date": "2025-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA221668",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "61328609",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500847260",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cc_otoc_ent_west_front_desk_pool12223135@oc.providencedirect.org",
            "affiliation": "Y",
            "affiliationName": "The Oregon Clinic PC",
            "address_1": "1815 SW Marlow Ave Ste 100",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972255185",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.