NPIMap

Organization Active NPI

Pacific Cataract and Laser Institute, Inc., P.C.

  • Ambulatory Surgical Clinic/Center
  • Tualatin, OR
National Provider Identifier
1265609945
Registry record updated Jul 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
071528 Issued in OR
Legal business name
PACIFIC CATARACT AND LASER INSTITUTE, INC., P.C.
Practice address
19801 SW 72ND Ave
Suite 150
Tualatin, OR 97062-8347
Phone
(503) 691-2283
Fax
(360) 503-6915
NPI assigned
May 13, 2008
Last updated
Jul 18, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2022

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

Authorized official

Name
Candice Auman
Title
Credentialing Specialist
Phone
(360) 242-3265

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 071528 OR Primary
Ophthalmologic Surgery Clinic/Center 261QS0132X 071528 OR

Addresses

Primary practice location

19801 SW 72ND Ave
Suite 150
Tualatin, OR 97062-8347

Mailing address

PO Box 1506
Chehalis, WA 98532-0409
Phone (360) 242-3008

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address asc.pclitualatin.p1@direct.pcli.nextgenshare.com Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040128000715 OR Part B Supplier - Clinic/Group Practice 7517864119 Receives reassigned benefits from 34 practitioners
1 other NPI on this enrollment
Practice locations: Portland, OR; Tualatin, OR
O20120808000984 OR Part B Supplier - Ambulatory Surgical Center 7517864119 Practice locations: Tualatin, OR

Other NPIs with the same Medicare PAC ID 14

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 14

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Pacific Cataract and Laser Institute Inc PCCCN 38C0001038
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
38D0982658Pacific Cataract and Laser Institute19801 SW 72ND Ave Suite 150, Tualatin, OR 97062Certificate of waiverJan 31, 2027

National Provider Directory

National Provider Directory
Tax ID family
Pacific Cataract and Laser Institute Inc PC12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1331 NW Lovejoy St
Ste 750
Portland, OR 97209
Phone (503) 535-2883

19801 SW 72nd Ave
Ste 150
Tualatin, OR 97062
Phone (503) 691-2283

Practitioners & affiliated clinicians

Practitioners 38

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 38

NPI Registry JSON

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

{
    "created_epoch": "1210636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658102400000",
    "number": "1265609945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1506",
            "city": "CHEHALIS",
            "state": "WA",
            "postal_code": "985320409",
            "telephone_number": "360-242-3008",
            "fax_number": "360-807-7687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19801 SW 72ND AVE",
            "address_2": "SUITE 150",
            "city": "TUALATIN",
            "state": "OR",
            "postal_code": "970628347",
            "telephone_number": "503-691-2283",
            "fax_number": "360-503-6915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC CATARACT AND LASER INSTITUTE, INC., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-13",
        "last_updated": "2022-07-18",
        "certification_date": "2022-07-18",
        "status": "A",
        "authorized_official_last_name": "AUMAN",
        "authorized_official_first_name": "CANDICE",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "360-242-3265"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "OR",
            "license": "071528",
            "primary": true
        },
        {
            "code": "261QS0132X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ophthalmologic Surgery",
            "state": "OR",
            "license": "071528",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "asc.pclitualatin.p1@direct.pcli.nextgenshare.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "19801 SW 72nd Ave",
            "address_2": "Suite 150",
            "city": "Tualatin",
            "state": "OR",
            "country_code": "US",
            "postal_code": "970628347",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Tualatin, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.