Individual provider Active NPI

Patricia Lee Fletter, AU.D, CCC-A

  • Audiologist
  • Portland, OR
National Provider Identifier
1124288386
Registry record updated Oct 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
22496 Issued in OR
Practice address
2230 NW Pettygrove St
Ste 120
Portland, OR 97210-2659
Phone
(503) 444-7676
Fax
(971) 319-6647
NPI assigned
Jun 11, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X 22496 OR Primary
Hearing Instrument Specialist 237700000X HAS-P-388467 OR

Addresses

Primary practice location

2230 NW Pettygrove St
Ste 120
Portland, OR 97210-2659

Mailing address

2230 NW Pettygrove St
Ste 120
Portland, OR 97210-2659
Phone (503) 444-7676

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20050312000086 OR Practitioner - Qualified Audiologist 8426003435 Reassigns benefits to 1 organization
I20240820001138 WA Practitioner - Qualified Audiologist 8426003435 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
22496ORMDAudiologist
HAS-P-388467ORMDHearing Instrument Specialist

Practice roles

OrganizationSpecialtyStatusNew patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Sep 10, 2018 Accepting new patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Sep 10, 2018 Accepting new patients
Northwest Ear Institute PC PastSince Oct 21, 2015 Accepting new patients
Willamette Ear Nose & Throat LLP PastSince Jul 10, 1992 Accepting new patients

Locations

10100 SE Sunnyside Rd
Clackamas, OR 97015
Phone (503) 571-2946

7201 N Interstate Ave
Portland, OR 97217
Phone (503) 240-4051

500 NE Multnomah St
Fl 11
Portland, OR 97232

2400 Lancaster Dr NE
Salem, OR 97305
Phone (503) 361-5400

1230 7th Ave
Longview, WA 98632
Phone (360) 575-4801

7101 NE 137th Ave
Vancouver, WA 98682
Phone (360) 418-6000

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/12838/brand/1/csg/1/fhir/r4

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1213142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476835200000",
    "number": "1124288386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2230 NW PETTYGROVE ST",
            "address_2": "STE 120",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972102659",
            "telephone_number": "503-444-7676",
            "fax_number": "971-319-6647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2230 NW PETTYGROVE ST",
            "address_2": "STE 120",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972102659",
            "telephone_number": "503-444-7676",
            "fax_number": "971-319-6647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FLETTER",
        "first_name": "PATRICIA",
        "middle_name": "LEE",
        "credential": "AU.D, CCC-A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-11",
        "last_updated": "2016-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "OR",
            "license": "22496",
            "primary": true
        },
        {
            "code": "237700000X",
            "taxonomy_group": "",
            "desc": "Hearing Instrument Specialist",
            "state": "OR",
            "license": "HAS-P-388467",
            "primary": false
        }
    ],
    "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 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.