Individual provider Active NPI

Jasdeep Singh Sandhu, PA-C

  • Physician Assistant
  • Vancouver, WA
National Provider Identifier
1043768377
Registry record updated Jul 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA60953038 Issued in WA
Practice address
501 SE 172ND Ave Ste 220
Vancouver, WA 98684-9542
Phone
(360) 882-2778
Fax
(360) 604-1717
NPI assigned
Sep 15, 2016
Last updated
Jul 23, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2019

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 PA189762 OR
Physician Assistant 363A00000X PA60953038 WA Primary

Addresses

Primary practice location

501 SE 172ND Ave Ste 220
Vancouver, WA 98684-9542

Mailing address

700 NE 87TH Ave
Vancouver, WA 98664-4896
Phone (360) 882-2778

Other practice location 1

2730 SW Moody Ave
Cl5Pa
Portland, OR 97201-5042
Phone (425) 315-3485

Other practice location 2

2850 SE Powell Valley Rd
Gresham, OR 97080
Phone (503) 666-5050

Other identifiers 1

IdentifierTypeStateIssuer
2109002MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, WA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20190226002867 OR Practitioner - Physician Assistant 9032458666 Reassigns benefits to 1 organization
I20190816000657 WA Practitioner - Physician Assistant 9032458666 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Oregon Health Sciences University School of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
The Vancouver Clinic Inc PSGroup PAC ID 3173436490, 580 clinicians

Practice addresses (Care Compare)

2005 W Main St
Battle Ground, WA 98604-4311
Phone (360) 882-2778

501 SE 172ND Ave
Vancouver, WA 98684-9542
Phone (360) 882-2778

700 NE 87TH Ave
Vancouver, WA 98664-1913
Phone (360) 882-2778

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA189762ORMDPhysician Assistant
PA60953038WAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
The Vancouver Clinic Inc PS CurrentSince Aug 26, 2019 Accepting new patients
The Vancouver Clinic Inc PS CurrentSince Aug 26, 2019 Accepting new patients
The Vancouver Clinic Pharmacy Past Accepting new patients

Locations

2005 W Main St
Ste 220
Battle Ground, WA 98604

501 SE 172nd Ave
Ste 220
Vancouver, WA 98684

700 NE 87th Ave
Vancouver, WA 98664
Phone (360) 397-1500

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1473897600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563840000000",
    "number": "1043768377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 NE 87TH AVE",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986644896",
            "telephone_number": "360-882-2778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 SE 172ND AVE STE 220",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986849542",
            "telephone_number": "360-882-2778",
            "fax_number": "360-604-1717"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2730 SW Moody Ave",
            "address_2": "CL5PA",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972015042",
            "country_code": "US",
            "telephone_number": "425-315-3485",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2850 SE Powell Valley Rd",
            "address_purpose": "LOCATION",
            "city": "Gresham",
            "state": "OR",
            "postal_code": "97080",
            "country_code": "US",
            "telephone_number": "503-666-5050",
            "fax_number": "503-666-1162",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SANDHU",
        "first_name": "JASDEEP",
        "middle_name": "SINGH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-09-15",
        "last_updated": "2019-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA189762",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA60953038",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2109002",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vancouver, WA

Sources for this page

Verify at the official NPI Registry.