Michael Takagi, PA-C
Individual provider Active NPI Medical Physician Assistant · Condon, OR
NPI 1285844407 · NPPES record last updated Jan 3, 2014
Key facts
- NPI
- 1285844407
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- PA-165453 (OR)
- Practice address
- 422 N Main St
Condon, OR 97823-7651 - Phone
- (541) 384-2061
- NPI assigned
- May 23, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Hospital & facility affiliations 5
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2006
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- South Gilliam County Health Dist
Practice addresses (Care Compare)
422 N Main St
Condon, OR 97823-7651
Phone (541) 384-5055
PO Box
Condon, OR 97823
Hospital & facility affiliations
- Pioneer Memorial Home Health
- Mid-Columbia Medical Center
- Good Shepherd Medical Center
- Pioneer Memorial Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140425000513 | OR | Practitioner - Physician Assistant | 6507950417 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AMD-295 | HI | MD | Physician Assistant |
| PA-791 | ID | MD | Physician Assistant |
| TL 568 | WY | MD | Physician Assistant |
| PA-165453 | OR | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Grand Teton Medical Clinic | Past | Accepting new patients | |
| First Medical Group, Inc. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | AMD-295 | HI | |
| Physician Assistant | 363A00000X | PA-791 | ID | |
| Physician Assistant | 363A00000X | TL 568 | WY | |
| Medical Physician Assistant | 363AM0700X | PA-165453 | OR | Yes |
Addresses
Primary practice location
422 N Main St
Condon, OR 97823-7651
Mailing address
422 N Main St
PO Box 597
Condon, OR 97823-7651
Phone (541) 384-2061
Other providers in Condon, OR
- Tara Lynn Nelson
- North Central Education Service District
- South Gilliam County Ambulance
- South Gilliam County Health Dist
- Kirk Roland Stonick
- Stephanie J. Thomas
All providers in Condon, OR · Medical Physician Assistant in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 3, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.