NPIMap

Individual provider Active NPI

Anthony Lance Johnson, PA-C

  • Physician Assistant
  • Lake Oswego, OR
National Provider Identifier
1174136725
Registry record updated Feb 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA208077 Issued in OR
Practice address
4103 Mercantile Dr
Lake Oswego, OR 97035-2556
Phone
(503) 850-9940
Fax
(503) 850-6709
NPI assigned
Aug 24, 2020
Last updated
Feb 8, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU
Physician Assistant 363A00000X PA208077 OR Primary
Student in an Organized Health Care Education/Training Program 390200000X NU

Addresses

Primary practice location

4103 Mercantile Dr
Lake Oswego, OR 97035-2556

Mailing address

4103 Mercantile Dr
Lake Oswego, OR 97035-2556
Phone (503) 850-9940

Other practice location 1

4311 11th Ave NE Ste 200
Seattle, WA 98105-6367
Phone (206) 616-4001

Other practice location 2

5302 NE 72nd Ave Apt N143
Vancouver, WA 98661-3573
Phone (253) 223-0231

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220215001614 OR Practitioner - Physician Assistant 6204229255 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Summit Orthopaedics, LLPGroup PAC ID 4789725607, 18 clinicians

Practice addresses (Care Compare)

4103 Mercantile Dr
Lake Oswego, OR 97035-2556
Phone (503) 850-9940

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Go to Ortho LLC Physician Assistant Past Accepting new patients
TS Pos Billings L L C Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

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": "1598227200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644278400000",
    "number": "1174136725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4103 MERCANTILE DR",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970352556",
            "telephone_number": "503-850-9940",
            "fax_number": "503-850-6709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4103 MERCANTILE DR",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970352556",
            "telephone_number": "503-850-9940",
            "fax_number": "503-850-6709"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4311 11th Ave NE Ste 200",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981056367",
            "country_code": "US",
            "telephone_number": "206-616-4001",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5302 NE 72nd Ave Apt N143",
            "address_purpose": "LOCATION",
            "city": "Vancouver",
            "state": "WA",
            "postal_code": "986613573",
            "country_code": "US",
            "telephone_number": "253-223-0231",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "ANTHONY",
        "middle_name": "LANCE",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-08-24",
        "last_updated": "2022-02-08",
        "certification_date": "2022-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA208077",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Oswego, OR

Sources for this page

Verify at the official NPI Registry.