Michelle Anne Radley, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA01411 Issued in OR

Practice address

3377 Riverbend Dr
Springfield, OR 97477-8803

Phone

(541) 222-6200

Fax

(541) 222-6182

NPI assigned

Nov 12, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Michelle Anne Altizer Former name

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Peacehealth Medical Group

  • Family Medicine Physician
  • Eugene, OR
  • NPI 1447207287
  Medicare reassignment
• Peacehealth Medical Group

  • Birthing Clinic/Center
  • Springfield, OR
  • NPI 1881860856
  NPD

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

{
    "created_epoch": "1226448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1322006400000",
    "number": "1164676441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 24410",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974020451",
            "telephone_number": "541-984-4301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3377 RIVERBEND DR",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "974778803",
            "telephone_number": "541-222-6200",
            "fax_number": "541-222-6182"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RADLEY",
        "first_name": "MICHELLE",
        "middle_name": "ANNE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-11-12",
        "last_updated": "2011-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA01411",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1164676441",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHELLE",
            "last_name": "ALTIZER",
            "middle_name": "ANNE",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Radiology Associates PC
• Radiology Associates PC
• Radiology Associates, Inc.
• Radiology Associates, PC
• Radiology Associates, PC
• Melissa Ann Radulski
• Kendra Ragan
• Rene Ragan
• Samantha Haley Rago
• Rainrock Treatment Center, LLC

• Physician Assistant in Springfield, OR
• Providers in Springfield, OR by specialty
• Physician Assistant in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2011; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.