Active NPI
Caitlin Hodges Dedeaux, PA
- Neurological Surgery Physician
- Portland, OR
National Provider Identifier
1093117228
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurological Surgery Physician
- License
- PA172323
- Practice address
- 3303 SW Bond Ave
Portland, OR 97239-4501 - Phone
- (503) 494-7737
- NPI assigned
- Sep 18, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA.200756 | LA | |
| Neurological Surgery Physician | 207T00000X | PA172323 | OR | Primary |
Addresses
Primary practice location
3303 SW Bond Ave
Portland, OR 97239-4501
Mailing address
245 SW Lincoln St Apt 5532
Portland, OR 97201-5052
Phone (225) 247-1375
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA172323 | OR | MD | Neurological Surgery Physician |
| PA.200756 | LA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1410998400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1446163200000",
"number": "1093117228",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "245 SW LINCOLN ST APT 5532",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972015052",
"telephone_number": "225-247-1375"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3303 SW BOND AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972394501",
"telephone_number": "503-494-7737"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEDEAUX",
"first_name": "CAITLIN",
"middle_name": "HODGES",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-09-18",
"last_updated": "2015-10-30",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "LA",
"license": "PA.200756",
"primary": false
},
{
"code": "207T00000X",
"taxonomy_group": "",
"desc": "Neurological Surgery",
"state": "OR",
"license": "PA172323",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.