Individual provider Active NPI

Daniel Albert Lowery, P.A.

  • Physician Assistant
  • Clearlake, CA
National Provider Identifier
1275623324
Registry record updated Oct 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA153530 Issued in OR
Practice address
15230 Lakeshore Dr
Clearlake, CA 95422-8107
Phone
(707) 995-4500
NPI assigned
Oct 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2021

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

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 13403 CA
Physician Assistant 363A00000X PA001267 ME
Physician Assistant 363A00000X PA0214 NV
Physician Assistant 363A00000X PA4803 AZ
Physician Assistant 363A00000X PA153530 OR Primary
Physician Assistant 363A00000X PA13403 CA

Addresses

Primary practice location

15230 Lakeshore Dr
Clearlake, CA 95422-8107

Mailing address

PO Box 6149
Aloha, OR 97007-0149
Phone (503) 352-8642

Other practice location 1

730 SE Oak St Ste D
Hillsboro, OR 97123-4245
Phone (503) 640-3724

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
I20120309000646 OR Practitioner - Physician Assistant 6608035662 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Valley Immediate Care, LLCGroup PAC ID 7618876723, 36 clinicians

Practice addresses (Care Compare)

1600 Delta Waters Rd
Suite 107
Medford, OR 97504-9114
Phone (541) 858-2515

162 NE Beacon Dr
Suite 103
Grants Pass, OR 97526-4260
Phone (541) 734-9030

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA4803AZMDPhysician Assistant
PA13403CAMDPhysician Assistant
PA001267MEMDPhysician Assistant
PA0214NVMDPhysician Assistant
PA153530ORMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Legacy Clinics LLC CurrentSince May 1, 2021 Accepting new patients
Valley Immediate Care, LLC PastSince Jan 21, 2022 Accepting new patients
Columbia Lutheran Charities Past Accepting new patients
Valley Immediate Care, LLC Past Accepting new patients
Care Partners Past Accepting new patients
Columbia Lutheran Charities Past Accepting new patients
Valley Immediate Care, LLC Past Accepting new patients

Locations

2725 SW Cedar Hills Blvd
Ste 200
Beaverton, OR 97005
Phone (503) 352-6000

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

Organizations & group practices 10

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": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634601600000",
    "number": "1275623324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6149",
            "city": "ALOHA",
            "state": "OR",
            "postal_code": "970070149",
            "telephone_number": "503-352-8642",
            "fax_number": "503-352-8658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15230 LAKESHORE DR",
            "city": "CLEARLAKE",
            "state": "CA",
            "postal_code": "954228107",
            "telephone_number": "707-995-4500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "730 SE Oak St Ste D",
            "address_purpose": "LOCATION",
            "city": "Hillsboro",
            "state": "OR",
            "postal_code": "971234245",
            "country_code": "US",
            "telephone_number": "503-640-3724",
            "fax_number": "503-640-3724",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LOWERY",
        "first_name": "DANIEL",
        "middle_name": "ALBERT",
        "name_prefix": "Mr.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-12",
        "last_updated": "2021-10-19",
        "certification_date": "2021-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "13403",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ME",
            "license": "PA001267",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NV",
            "license": "PA0214",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "PA4803",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA153530",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA13403",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clearlake, CA

Sources for this page

Verify at the official NPI Registry.