Lilian Renata Bornio Carrillo

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA211394 Issued in OR

Practice address

16463 Boones Ferry Rd Ste 300
Lake Oswego, OR 97035-4376

Phone

(503) 658-9351

Fax

(541) 708-5934

NPI assigned

Feb 23, 2021

Last updated

Feb 15, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Specialty

Physician Assistant

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Nisha Jackson IncGroup PAC ID 6305147745, 47 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Interoperability endpoints

• Direct secure messaging: lillian.carrillopac.p1@direct.opm.nextgenshare.com

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.

• Nisha Jackson PC

  • Nurse Practitioner
  • Medford, OR
  • NPI 1124499124
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1614038400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707955200000",
    "number": "1275127979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "232 NW 6TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972093609",
            "telephone_number": "503-294-1681",
            "fax_number": "503-294-4321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16463 BOONES FERRY RD STE 300",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970354376",
            "telephone_number": "503-658-9351",
            "fax_number": "541-708-5934"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BORNIO CARRILLO",
        "first_name": "LILIAN",
        "middle_name": "RENATA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-02-23",
        "last_updated": "2024-02-15",
        "certification_date": "2024-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA211394",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "OR",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kirsten Elizabeth Bonish
• Anna Ruth Booth, MA
• Emily Booth
• Louisa Borecki
• Kari Borgen
• Pamela K Bosa, NP
• Carlie Boswell
• Larry Bowden, DMD
• Jessica Rochelle Bradburn, M.A.
• John Rodgers Braddock, M.D.

• Physician Assistant in Lake Oswego, OR
• Providers in Lake Oswego, OR by specialty
• Physician Assistant in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 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.