Individual provider Active NPI

Courtney Elizabeth Perry, PA-C

  • Physician Assistant
  • Walnut Creek, CA
National Provider Identifier
1275003204
Registry record updated Dec 3, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
55921 Issued in CA
Practice address
450 N Wiget LN
Walnut Creek, CA 94598-2408
Phone
(925) 691-9806
NPI assigned
Dec 3, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 55921 CA Primary

Addresses

Primary practice location

450 N Wiget LN
Walnut Creek, CA 94598-2408

Mailing address

1742 Mary Dr
Pleasant Hill, CA 94523-2262
Phone (925) 768-9425

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, WA2 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

Enrollment IDStateProvider typePAC IDDetails
I20200916002495 OR Practitioner - Physician Assistant 2567701642 Reassigns benefits to 1 organization
I20200917000444 WA Practitioner - Physician Assistant 2567701642 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Legacy Clinics LLCGroup PAC ID 0244144004, 714 clinicians

Practice addresses (Care Compare)

1130 NW 22ND Ave
Suite 220
Portland, OR 97210-2969
Phone (503) 413-8988

2850 SE Powell Valley Rd
Gresham, OR 97080-1494
Phone (503) 666-5050

Merit-based Incentive Payment System (MIPS)

Final score
94.62 of 100Reported as apm
Quality
77.21
Promoting interoperability
99.06
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Legacy Clinics LLC CurrentSince Sep 11, 2020 Accepting new patients
Legacy Salmon Creek Hospital Past Accepting new patients

Locations

2870 SW Cedar Hills Blvd
Beaverton, OR 97005
Phone (503) 646-9222

22262 NE Glisan St
Gresham, OR 97030
Phone (503) 489-2024

2850 SE Powell Valley Rd
Gresham, OR 97080
Phone (503) 666-5050

9361 SE 82nd Ave
Happy Valley, OR 97086
Phone (503) 457-4301

3 Monroe Pkwy
Ste X
Lake Oswego, OR 97035
Phone (503) 679-3748

1900 McLoughlin Blvd
Ste 127
Oregon City, OR 97045
Phone (503) 305-6159

1900 McLoughlin Blvd
Ste 67
Oregon City, OR 97045

4800 SW 76th Ave
Portland, OR 97225
Phone (971) 808-0665

1130 NW 22nd Ave
Ste 220
Portland, OR 97210
Phone (503) 413-4134

21900 Willamette Dr
Ste 209
West Linn, OR 97068
Phone (971) 274-0038

305 SE Chkalov Dr
Ste 170
Vancouver, WA 98683
Phone (360) 799-3912

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.

NPI Registry JSON

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

{
    "created_epoch": "1543795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543795200000",
    "number": "1275003204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1742 MARY DR",
            "city": "PLEASANT HILL",
            "state": "CA",
            "postal_code": "945232262",
            "telephone_number": "925-768-9425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 N WIGET LN",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945982408",
            "telephone_number": "925-691-9806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PERRY",
        "first_name": "COURTNEY",
        "middle_name": "ELIZABETH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-12-03",
        "last_updated": "2018-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "55921",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Walnut Creek, CA

Sources for this page

Verify at the official NPI Registry.