Active NPI
Paul Pendergraft, AU.D.
- Audiologist
- Portland, OR
National Provider Identifier
1134520604
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Audiologist
- License
- 030803
- Practice address
- 316 NE 60TH Ave
Apt A1
Portland, OR 97213-3765 - Phone
- (336) 339-2588
- NPI assigned
- Sep 15, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Audiologist | 231H00000X | 030803 | OR | Primary |
Addresses
Primary practice location
316 NE 60TH Ave
Apt A1
Portland, OR 97213-3765
Mailing address
316 NE 60TH Ave
Apt A1
Portland, OR 97213-3765
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 030803 | OR | MD | Audiologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1410739200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1410739200000",
"number": "1134520604",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "316 NE 60TH AVE",
"address_2": "APT A1",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972133765"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "316 NE 60TH AVE",
"address_2": "APT A1",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972133765",
"telephone_number": "336-339-2588"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENDERGRAFT",
"first_name": "PAUL",
"name_prefix": "Dr.",
"credential": "AU.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-09-15",
"last_updated": "2014-09-15",
"status": "A"
},
"taxonomies": [
{
"code": "231H00000X",
"taxonomy_group": "",
"desc": "Audiologist",
"state": "OR",
"license": "030803",
"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 Sep 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.