Individual provider Active NPI

Ian Cavigli, PA-C

  • Physician Assistant
  • Stayton, OR
National Provider Identifier
1003624545
Registry record updated May 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1401 N 10TH Ave Ste 100
Stayton, OR 97383-1486
Phone
(503) 769-6386
Fax
(503) 769-5647
NPI assigned
Dec 30, 2024
Last updated
May 30, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 30, 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 PA224199 OR
Physician Assistant 363A00000X NU Primary

Addresses

Primary practice location

1401 N 10TH Ave Ste 100
Stayton, OR 97383-1486

Mailing address

1401 N 10TH Ave Ste 100
Stayton, OR 97383-1486
Phone (503) 769-6386

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
I20250414000435 OR Practitioner - Physician Assistant 2567986466 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Iowa, RJ & L Carver College of Medicine, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Santiam Memorial HospitalGroup PAC ID 6103729751, 128 clinicians

Practice addresses (Care Compare)

1401 N 10TH Ave
Suite 100
Stayton, OR 97383-1486
Phone (503) 769-6386

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Santiam Memorial Hospital CurrentSince Apr 21, 2025 Accepting new patients
Santiam Memorial Hospital CurrentSince Apr 21, 2025 Accepting new patients
Santiam Memorial Hospital Past Accepting new patients

Locations

1375 N 10th Ave
Ste B
Stayton, OR 97383
Phone (503) 769-7546

1401 N 10th Ave
Ste 100
Stayton, OR 97383
Phone (503) 769-6386

1401 N 10th Ave
Ste 200
Stayton, OR 97383
Phone (503) 769-7151

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14369/brand/7/csg/1/fhir/r4

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

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": "1735516800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748563200000",
    "number": "1003624545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 N 10TH AVE STE 100",
            "city": "STAYTON",
            "state": "OR",
            "postal_code": "973831486",
            "telephone_number": "503-769-6386"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 N 10TH AVE STE 100",
            "city": "STAYTON",
            "state": "OR",
            "postal_code": "973831486",
            "telephone_number": "503-769-6386",
            "fax_number": "503-769-5647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAVIGLI",
        "first_name": "IAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-12-30",
        "last_updated": "2025-05-30",
        "certification_date": "2025-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA224199",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stayton, OR

Sources for this page

Verify at the official NPI Registry.