Individual provider Active NPI

Paula Jean Prince, AGACNP

  • Gerontology Nurse Practitioner
  • Portland, OR
National Provider Identifier
1114165503
Registry record updated Feb 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
201605367NP-PP Issued in OR
Practice address
9135 SW Barnes Rd Ste 461
Portland, OR 97225-6643
Phone
(503) 216-1150
NPI assigned
Jan 23, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Medicine Registered Nurse 163WC0200X 097006495RN OR
Acute Care Nurse Practitioner 363LA2100X 201605367NP-PP OR
Gerontology Nurse Practitioner 363LG0600X 201605367NP-PP OR Primary

Addresses

Primary practice location

9135 SW Barnes Rd Ste 461
Portland, OR 97225-6643

Mailing address

PO Box 3158
Portland, OR 97208-3158

Other practice location 1

2242 NE 21st Ave
Portland, OR 97212
Phone (503) 502-1935

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address pprince499982@oc.providencedirect.org

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
I20160922000425 OR Practitioner - Nurse Practitioner 9931496742 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Providence Health and Services OregonGroup PAC ID 0648183608, 1,423 clinicians
Providence Health and Services - OregonGroup PAC ID 9335057447, 212 clinicians

Practice addresses (Care Compare)

Portland, OR 97210

1321 NE 99TH Ave
Suite 200
Portland, OR 97220-9439
Phone (503) 215-4250

9135 SW Barnes Rd
Portland, OR 97225-6643

9205 SW Barnes Rd
Portland, OR 97225-6603

Hospital & facility affiliations

  • Providence St Vincent Medical Center Hospital, Portland, OR, CCN 380004

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
201605367NP-PPORMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services Oregon CurrentSince Aug 15, 2016 Accepting new patients
Providence Health & Services Oregon CurrentSince Aug 15, 2016 Accepting new patients
Providence Health & Services Oregon CurrentSince Aug 15, 2016 Accepting new patients
Providence Health & Services - Oregon CurrentSince Aug 15, 2016 Accepting new patients
Providence Health & Services - Oregon CurrentSince Aug 15, 2016 Accepting new patients
Providence Health & Services - Oregon CurrentSince Aug 15, 2016 Accepting new patients
Providence Health & Services Oregon Current Accepting new patients

Locations

5050 NE Hoyt St
Ste 240
Portland, OR 97213
Phone (503) 215-6480

4805 NE Glisan St
Portland, OR 97213
Phone (503) 215-1111

1321 NE 99th Ave
Ste 200
Portland, OR 97220
Phone (503) 215-4250

9205 SW Barnes Rd
Portland, OR 97225
Phone (503) 216-1234

9135 SW Barnes Rd
Ste 461
Portland, OR 97225
Phone (503) 216-1150

5050 NE Hoyt St
Ste 454
Portland, OR 97213
Phone (503) 215-6405

Interoperability endpoints

  • Direct secure messaging: pprince499982@oc.providencedirect.org

Organizations & group practices 7

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 1

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": "1232668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613347200000",
    "number": "1114165503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3158",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9135 SW BARNES RD STE 461",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972256643",
            "telephone_number": "503-216-1150"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2242 NE 21st Ave",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "97212",
            "country_code": "US",
            "telephone_number": "503-502-1935",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PRINCE",
        "first_name": "PAULA",
        "middle_name": "JEAN",
        "credential": "AGACNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-01-23",
        "last_updated": "2021-02-15",
        "certification_date": "2021-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Critical Care Medicine",
            "state": "OR",
            "license": "097006495RN",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "OR",
            "license": "201605367NP-PP",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "OR",
            "license": "201605367NP-PP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pprince499982@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "9135 SW Barnes Rd Ste 461",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972256643",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.