NPIMap

Individual provider Active NPI

Evangeline Friedbaum, PA-C

  • Physician Assistant
  • Forest Grove, OR
National Provider Identifier
1073225348
Registry record updated May 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1909 Mountain View LN Ste 200
Forest Grove, OR 97116-2894
Phone
(503) 359-4773
Fax
(503) 359-3809
NPI assigned
Dec 19, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 23, 2025

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 Primary

Addresses

Primary practice location

1909 Mountain View LN Ste 200
Forest Grove, OR 97116-2894

Mailing address

1909 Mountain View LN Ste 200
Forest Grove, OR 97116-2894
Phone (503) 359-4773

Other identifiers 1

IdentifierTypeStateIssuer
500831809MedicaidOR

Other names 1

  • Evie Becker Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240212003576 OR Practitioner - Physician Assistant 6204279789 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Timothy J Gray DO LLCGroup PAC ID 1355390584, 11 clinicians

Practice addresses (Care Compare)

1909 Mountain View LN
Suite 200
Forest Grove, OR 97116-2894
Phone (503) 359-4773

Hospital & facility affiliations

National Provider Directory

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

Interoperability endpoints

  • Direct secure messaging: evangeline.friedbaum.1@26386.direct.athenahealth.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 12

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": "1671408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747958400000",
    "number": "1073225348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1909 MOUNTAIN VIEW LN STE 200",
            "city": "FOREST GROVE",
            "state": "OR",
            "postal_code": "971162894",
            "telephone_number": "503-359-4773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1909 MOUNTAIN VIEW LN STE 200",
            "city": "FOREST GROVE",
            "state": "OR",
            "postal_code": "971162894",
            "telephone_number": "503-359-4773",
            "fax_number": "503-359-3809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FRIEDBAUM",
        "first_name": "EVANGELINE",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-12-19",
        "last_updated": "2025-05-23",
        "certification_date": "2025-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500831809",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "EVIE",
            "last_name": "BECKER",
            "credential": "PA-C",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Forest Grove, OR

Sources for this page

Verify at the official NPI Registry.