Kyle Pernula, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA217844 Issued in OR

Practice address

10151 SE Sunnyside Rd
Clackamas, OR 97015-6913

Phone

(503) 647-6456

NPI assigned

Feb 26, 2024

Last updated

May 30, 2024By the provider in NPPES

Sex

Male

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, 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

Specialty

Physician Assistant

Education

University of Nebraska College of Medicine, 2024

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Active Recovery TMS PLLC

  dba Active Path Mental Health

  • Psychiatry Physician
  • Clackamas, OR
  • NPI 1881287787

  WA

  Medicare reassignment Care Compare group
• Active Recovery TMS PLLC

  • Psychiatry Physician
  • Salem, OR
  • NPI 1316752033
  NPD (past)
• TMS Physician Services, P.C.

  • Psychiatry Physician
  • Portland, OR
  • NPI 1881139913
  NPD (past)

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

{
    "created_epoch": "1708905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717027200000",
    "number": "1275399248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10151 SE SUNNYSIDE RD",
            "city": "CLACKAMAS",
            "state": "OR",
            "postal_code": "970156913",
            "telephone_number": "503-647-6456",
            "fax_number": "503-296-2022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10151 SE SUNNYSIDE RD",
            "city": "CLACKAMAS",
            "state": "OR",
            "postal_code": "970156913",
            "telephone_number": "503-647-6456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PERNULA",
        "first_name": "KYLE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-02-26",
        "last_updated": "2024-05-30",
        "certification_date": "2024-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA217844",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sara Cassandra Peddicord
• Michael Joseph Peizner, PHARMACIST
• Rachel Lynn Pena, RDH
• Zachary G Pena, M.D.
• Laurel Perilli, PT
• Kristen Diane Perry, PA-C
• Letitia Renee Perry, LCSW
• Anna Persmark, MD
• Andrea Christine Pertoso, PA-C
• Jon Peters, MD

• Physician Assistant in Clackamas, OR
• Providers in Clackamas, 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.