Individual provider Active NPI

Katherine Kelly Fossetta, PHYSICIAN ASSISTANT

  • Student in an Organized Health Care Education/Training Program
  • Portland, OR
National Provider Identifier
1013758911
Registry record updated Jun 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
2730 S Moody Ave
Portland, OR 97201-5042
Phone
(503) 494-9645
NPI assigned
Jun 4, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 4, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

2730 S Moody Ave
Portland, OR 97201-5042

Mailing address

2730 S Moody Ave
Portland, OR 97201-5042

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20260213000907 WA Practitioner - Physician Assistant 0143700757 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Oregon Health Sciences University School of Medicine, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Post Acute Rehabilitation Physicians LLCGroup PAC ID 7214334614, 44 clinicians

Practice addresses (Care Compare)

2508 7TH St SE
Puyallup, WA 98374-1105
Phone (801) 215-9309

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Post Acute Rehabilitation Physicians LLC CurrentSince Jan 9, 2026 Accepting new patients

Locations

11120 NE 33rd Pl
Ste 202
Bellevue, WA 98004
Phone (206) 426-2584

2508 7th St SE
Puyallup, WA 98374
Phone (253) 841-6600

4430 Talbot Rd S
Renton, WA 98055
Phone (425) 226-7500

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1717459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717459200000",
    "number": "1013758911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2730 S MOODY AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972015042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2730 S MOODY AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972015042",
            "telephone_number": "503-494-9645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOSSETTA",
        "first_name": "KATHERINE",
        "middle_name": "KELLY",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-06-04",
        "last_updated": "2024-06-04",
        "certification_date": "2024-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.