Individual provider Active NPI

Alyssa R Rollins, PA

  • Physician Assistant
  • Salem, OR
National Provider Identifier
1225569395
Registry record updated Mar 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA181536 Issued in OR
Practice address
4999 Skyline Rd S Ste 100
Salem, OR 97306-0001
Phone
(503) 364-4005
Fax
(503) 364-4006
NPI assigned
Mar 21, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Physician Assistant 363A00000X PA181536 OR Primary

Addresses

Primary practice location

4999 Skyline Rd S Ste 100
Salem, OR 97306-0001

Mailing address

4999 Skyline Rd S Ste 100
Salem, OR 97306-0001
Phone (503) 364-4005

Other practice location 1

2485 12th St SE
Salem, OR 97302-2151
Phone (503) 363-8047

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20170421000384 OR Practitioner - Physician Assistant 1456637719 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Praxis Health PCGroup PAC ID 8325941446, 174 clinicians

Practice addresses (Care Compare)

4999 Skyline Rd S
Suite 100
Salem, OR 97306-0001
Phone (503) 364-4005

Hospital & facility affiliations

  • Mission Home Health of Salem Home health agency, Salem, OR, CCN 387108
  • Salem Hospital Hospital, Salem, OR, CCN 380051
  • Salem Health West Valley Hospital, Dallas, OR, CCN 381308

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA181536ORMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Praxis Health, PC CurrentSince Jan 1, 2020 Accepting new patients
Praxis Health, PC CurrentSince Jan 1, 2020 Accepting new patients

Locations

4999 Skyline Rd S
Ste 100
Salem, OR 97306
Phone (503) 364-4005

Organizations & group practices 2

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.

Hospital & facility affiliations 3

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": "1490054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648598400000",
    "number": "1225569395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4999 SKYLINE RD S STE 100",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973060001",
            "telephone_number": "503-364-4005",
            "fax_number": "503-364-4006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4999 SKYLINE RD S STE 100",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973060001",
            "telephone_number": "503-364-4005",
            "fax_number": "503-364-4006"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2485 12th St SE",
            "address_purpose": "LOCATION",
            "city": "Salem",
            "state": "OR",
            "postal_code": "973022151",
            "country_code": "US",
            "telephone_number": "503-363-8047",
            "fax_number": "503-363-6571",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROLLINS",
        "first_name": "ALYSSA",
        "middle_name": "R",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-03-21",
        "last_updated": "2022-03-30",
        "certification_date": "2022-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA181536",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, OR

Sources for this page

Verify at the official NPI Registry.