Individual provider Active NPI

Gregory Sopka, PA

  • Physician Assistant
  • Coos Bay, OR
National Provider Identifier
1043712383
Registry record updated Mar 2, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1900 Woodland Dr
Coos Bay, OR 97420-2045
Phone
(541) 267-5151
NPI assigned
Mar 2, 2018
Last updated
Mar 2, 2018By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 2, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X OR Primary

Addresses

Primary practice location

1900 Woodland Dr
Coos Bay, OR 97420-2045

Mailing address

2180 Western Meadows Dr
Flushing, MI 48433-9447
Phone (810) 347-1881

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
I20180326002018 OR Practitioner - Physician Assistant 5496017758 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bay Area Hospital DistrictGroup PAC ID 2163331000, 117 clinicians

Practice addresses (Care Compare)

1775 Thompson Rd
Coos Bay, OR 97420-2125
Phone (541) 269-8280

2650 N 17TH St
Coos Bay, OR 97420-2134
Phone (541) 269-8282

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Bay Area Hospital District CurrentSince Oct 1, 2024 Accepting new patients
North Bend Medical Center Inc Single Specialty CurrentSince May 1, 2018 Accepting new patients

Locations

1775 Thompson Rd
Coos Bay, OR 97420
Phone (541) 269-8090

1900 Woodland Dr
Coos Bay, OR 97420
Phone (541) 267-5151

2650 N 17th St
Coos Bay, OR 97420
Phone (541) 267-5411

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 4

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": "1519948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1519948800000",
    "number": "1043712383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2180 WESTERN MEADOWS DR",
            "city": "FLUSHING",
            "state": "MI",
            "postal_code": "484339447",
            "telephone_number": "810-347-1881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 WOODLAND DR",
            "city": "COOS BAY",
            "state": "OR",
            "postal_code": "974202045",
            "telephone_number": "541-267-5151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOPKA",
        "first_name": "GREGORY",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-03-02",
        "last_updated": "2018-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Coos Bay, OR

Sources for this page

Verify at the official NPI Registry.