Mason D Spong, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

214752 Issued in OR

Practice address

2701 NW Vaughn St Ste 470
Portland, OR 97210-5326

Phone

(503) 751-2216

Fax

(503) 296-2022

NPI assigned

Jan 30, 2024

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA, OR2 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

Louisiana State University School of Medicine in New Orleans, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Active Recovery TMS PLLCGroup PAC ID 9032528047, 7 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Active Recovery TMS PLLC

  • Psychiatry Physician
  • Clackamas, OR
  • NPI 1881287787

  WA

  Medicare reassignment Care Compare group
• Active Recovery TMS PLLC

  • Psychiatry Physician
  • Salem, OR
  • NPI 1316752033
  NPD (past)

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

{
    "created_epoch": "1706572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717027200000",
    "number": "1255193785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3265 NE ALBERTA ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972117040",
            "telephone_number": "985-264-4859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2701 NW VAUGHN ST STE 470",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972105326",
            "telephone_number": "503-751-2216",
            "fax_number": "503-296-2022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPONG",
        "first_name": "MASON",
        "middle_name": "D",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-01-30",
        "last_updated": "2024-05-30",
        "certification_date": "2024-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "214752",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Moriah Splonskowski
• Cathy C Spofford, LCSW
• Sarah Spofford
• Molly G Spohn, COTA/L
• Ryan Elizabeth Spokes, PHD
• Patricia M Spooner, CNM
• Rachel Spooner
• Erika Nguyen Sporleder, CRNA
• Sport Psychology Institute Northwest
• Sportland Acupuncture LLC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2024; 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.