Justin Hadaller

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA60906 Issued in CA

Practice address

475 Bruce St
Yreka, CA 96097-3474

Phone

(530) 842-4121

Fax

(530) 841-0913

NPI assigned

Sep 23, 2014

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in OR, CA2 enrollments

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 2

Specialty

Physician Assistant

Education

University of Washington School of Medicine, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Asante Physician PartnersGroup PAC ID 8325206246, 227 clinicians

Siskiyou Hospital IncGroup PAC ID 1254223134, 96 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Fairchild Medical Center Hospital, Yreka, CA, CCN 051316

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jhadaller2463625@oc.providencedirect.org
• Direct secure messaging: jhadaller142079@ghc.direct-ci.net

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.

• Siskiyou Hospital, Inc.

  • Critical Access Hospital
  • Yreka, CA
  • NPI 1093892275
  Medicare reassignment Care Compare group NPD
• Asante Physician Partners

  • Family Medicine Physician
  • Medford, OR
  • NPI 1922381326
  Medicare reassignment Care Compare group
• Legacy Clinics LLC

  • Clinic/Center
  • Portland, OR
  • NPI 1902827272
  Medicare reassignment
• Northwest Acute Care Specialists PC

  • Emergency Medicine Physician
  • Portland, OR
  • NPI 1215983200
  Medicare reassignment

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Siskiyou Hospital, Inc.

  • Critical Access Hospital
  • Yreka, CA
  • NPI 1093892275
  Care Compare affiliation
• Siskiyou Hospital, Inc.

  • Critical Access Hospital
  • Yreka, CA
  • NPI 1952701369
  Care Compare affiliation

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

{
    "created_epoch": "1411430400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649721600000",
    "number": "1134521909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "475 BRUCE ST",
            "city": "YREKA",
            "state": "CA",
            "postal_code": "960973474",
            "telephone_number": "530-842-4121",
            "fax_number": "530-841-0913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "475 BRUCE ST",
            "city": "YREKA",
            "state": "CA",
            "postal_code": "960973474",
            "telephone_number": "530-842-4121",
            "fax_number": "530-841-0913"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HADALLER",
        "first_name": "JUSTIN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-09-23",
        "last_updated": "2022-04-12",
        "certification_date": "2022-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA60494109",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "OR",
            "license": "PA171878",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA60906",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• April Jeanne Gray, PMHNP
• Diane Marie Gularte, LMFT
• Salim Gumati, DPT
• Rico M Gutierrez
• Gakwaya Habiyaremye, MD
• Jennifer C Hall, MD
• Lauree Hall
• Monica Jane Hall
• Roy Victor Hall Jr.
• Jeffrey M Hamlin, P.A.

• Physician Assistant in Yreka, CA
• Providers in Yreka, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.