Individual provider Active NPI

Vitaly Layvant, PA-C

  • Physician Assistant
  • Salem, OR
National Provider Identifier
1043988447
Registry record updated Aug 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA204341 Issued in OR
Practice address
2973 12TH St SE
Salem, OR 97302-3162
Phone
(503) 561-7100
NPI assigned
Aug 31, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 204341 OR
Physician Assistant 363A00000X PA204341 OR Primary

Addresses

Primary practice location

2973 12TH St SE
Salem, OR 97302-3162

Mailing address

2973 12TH St SE
Salem, OR 97302-3162

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
I20220210002540 OR Practitioner - Physician Assistant 1850789306 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Salem HealthGroup PAC ID 8628986668, 470 clinicians

Practice addresses (Care Compare)

2973 12TH St SE
Salem, OR 97302-3162
Phone (503) 561-7100

665 Winter St SE
Salem, OR 97301-3934
Phone (503) 561-5200

890 Oak St SE
Salem, OR 97301-3905
Phone (503) 561-5200

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
204341ORMDUrology Physician
PA204341ORMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Willamette Urology PC CurrentSince Sep 27, 2021 Accepting new patients
Salem Health CurrentSince Dec 15, 2024 Accepting new patients

Locations

665 Winter St SE
Salem, OR 97301
Phone (503) 370-5634

2973 12th St SE
Salem, OR 97302
Phone (503) 561-7100

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • Direct secure messaging: vlayvant311765@direct.salemhealth.org

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 and National Provider Directory roles.

Hospital & facility affiliations 5

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": "1630368000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755648000000",
    "number": "1043988447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2973 12TH ST SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973023162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2973 12TH ST SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973023162",
            "telephone_number": "503-561-7100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAYVANT",
        "first_name": "VITALY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-08-31",
        "last_updated": "2025-08-20",
        "certification_date": "2025-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "OR",
            "license": "204341",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA204341",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, OR

Sources for this page

Verify at the official NPI Registry.