Individual provider Active NPI

Julia Havron

  • Physician Assistant
  • Portland, OR
National Provider Identifier
1275166209
Registry record updated Nov 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA202569 Issued in OR
Practice address
9155 SW Barnes Rd Ste 440
Portland, OR 97225-6631
Phone
(503) 935-8500
Fax
(503) 935-8505
NPI assigned
Feb 18, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 22, 2023

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 PA202569 OR Primary

Addresses

Primary practice location

9155 SW Barnes Rd Ste 440
Portland, OR 97225-6631

Mailing address

541 NE 20TH Ave Ste 225
Portland, OR 97232-2895
Phone (503) 963-2801

Other practice location 1

5050 NE Hoyt St Ste 359
Portland, OR 97213-2983
Phone (503) 935-8501

Other identifiers 1

IdentifierTypeStateIssuer
500792553MedicaidOR

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address referringmns@1243.direct.myezyaccess.com The Oregon Clinic PC

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
I20210520002122 OR Practitioner - Physician Assistant 4486053634 Reassigns benefits to 2 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services Oregon CurrentSince Sep 1, 2024 Accepting new patients
Providence Health & Services - Oregon CurrentSince Sep 1, 2024 Accepting new patients
The Oregon Clinic, PC CurrentSince Jun 1, 2021 Accepting new patients
Providence Health & Services - Oregon Past Accepting new patients

Locations

4805 NE Glisan St
Ste 3E14
Portland, OR 97213

5050 NE Hoyt St
Ste 359
Portland, OR 97213
Phone (503) 935-8501

5050 NE Hoyt St
Ste 655
Portland, OR 97213
Phone (503) 239-6673

541 NE 20th Ave
Ste 225
Portland, OR 97232
Phone (503) 963-2801

4805 NE Glisan St
Portland, OR 97213
Phone (503) 215-1111

9155 SW Barnes Rd
Ste 440
Portland, OR 97225
Phone (503) 297-3766

Organizations & group practices 5

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": "1581984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700611200000",
    "number": "1275166209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "541 NE 20TH AVE STE 225",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972322895",
            "telephone_number": "503-963-2801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9155 SW BARNES RD STE 440",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972256631",
            "telephone_number": "503-935-8500",
            "fax_number": "503-935-8505"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5050 NE Hoyt St Ste 359",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972132983",
            "country_code": "US",
            "telephone_number": "503-935-8501",
            "fax_number": "503-935-8506",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HAVRON",
        "first_name": "JULIA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-02-18",
        "last_updated": "2023-11-22",
        "certification_date": "2023-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA202569",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500792553",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "referringmns@1243.direct.myezyaccess.com",
            "affiliation": "Y",
            "affiliationName": "The Oregon Clinic PC",
            "address_1": "9155 SW Barnes Rd Ste 440",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972256631",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.