Theresa M Rardin, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA182032 Issued in OR

Practice address

24900 SE Stark St Ste 208
Gresham, OR 97030-3382

Phone

(503) 666-8149

NPI assigned

Apr 17, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

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.

• Eastside Foot and Ankle

  • Foot & Ankle Surgery Podiatrist
  • Portland, OR
  • NPI 1669884003
  NPD (past)

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

{
    "created_epoch": "1492387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1492387200000",
    "number": "1013441997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4432 NE CESAR E CHAVEZ BLVD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972118232",
            "telephone_number": "503-867-0019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24900 SE STARK ST STE 208",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970303382",
            "telephone_number": "503-666-8149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RARDIN",
        "first_name": "THERESA",
        "middle_name": "M",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-04-17",
        "last_updated": "2017-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA182032",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert William Ramsey, D.C.
• Hiren T Rana, MD
• Allie Marie Randall
• Robert Rankin
• Katheryn Rapson, DMD
• Erik Michael Rasmusson
• Pamela J. Rathbone, WHCNP
• Meghan Rathbun, CSWA, CADC-I
• Angie Agnes Rawley, DMD
• Salina Ray

• Physician Assistant in Gresham, OR
• Providers in Gresham, OR by specialty
• Physician Assistant in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.