Active NPI
Scot Shoichi Itomura, PA-C
- Physician Assistant
- Lake Oswego, OR
National Provider Identifier
1275669806
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA01184
- Practice address
- 17704 Jean Way
Ste 101
Lake Oswego, OR 97035-5497 - Phone
- (503) 699-0370
- NPI assigned
- Feb 26, 2007
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA01184 | OR | Primary |
Addresses
Primary practice location
17704 Jean Way
Ste 101
Lake Oswego, OR 97035-5497
Mailing address
1013 SW Gaines St
Portland, OR 97239-2975
Phone (503) 721-0828
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA01184 | OR | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172448000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1275669806",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1013 SW GAINES ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972392975",
"telephone_number": "503-721-0828"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17704 JEAN WAY",
"address_2": "STE 101",
"city": "LAKE OSWEGO",
"state": "OR",
"postal_code": "970355497",
"telephone_number": "503-699-0370"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ITOMURA",
"first_name": "SCOT",
"middle_name": "SHOICHI",
"name_prefix": "Mr.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "OR",
"license": "PA01184",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Oswego, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.