Jennifer K. Van Atta, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA01150 Issued in OR

Practice address

15755 SW Sequoia Pkwy Ste 200
Tigard, OR 97224-7166

Phone

(503) 639-6002

Fax

(503) 639-1403

NPI assigned

Oct 23, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

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

Specialty

Physician Assistant

Education

Other, 2006

Medicare assignment

May accept Medicare assignment

Group practices

Columbia Gorge Medical Center PCGroup PAC ID 8628066115, 12 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Providence Hood River Memorial Hospital Hospital, Hood River, OR, CCN 381318

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jvanatta@landmarkhealth-direct.org

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.

• Columbia Gorge Medical Center PC

  • Clinic/Center
  • Hood River, OR
  • NPI 1558346064
  Medicare reassignment Care Compare group NPD
• Legacy Clinics LLC

  • Clinic/Center
  • Portland, OR
  • NPI 1902827272
  Medicare reassignment
• Mid-Columbia Medical Center

  • General Practice Physician
  • The Dalles, OR
  • NPI 1053409599
  NPD (past)
• Mid-Columbia Medical Center

  • Rural Health Clinic/Center
  • The Dalles, OR
  • NPI 1154351336

  Physician Assistant

  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Providence Health & Services Oregon

  • Critical Access Hospital
  • Hood River, OR
  • NPI 1255429338
  Care Compare affiliation

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

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1359072000000",
    "number": "1295818383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15755 SW SEQUOIA PKWY STE 200",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972247166",
            "telephone_number": "503-639-6002",
            "fax_number": "503-639-1403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15755 SW SEQUOIA PKWY STE 200",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972247166",
            "telephone_number": "503-639-6002",
            "fax_number": "503-639-1403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN ATTA",
        "first_name": "JENNIFER",
        "middle_name": "K.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-23",
        "last_updated": "2013-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA01150",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001920",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500604336",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "93-1280904",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Adela Rose Valdes
• Morgan Barnabas Valentine
• Summer Joy Valentine
• Iris Valet, MSW
• Alexandra Valls
• Erin Jamie Van Dyke, PA-C
• Carol Anne Van Horn, R.PH. MBA
• Heather Van Houten, PA-C
• Linnea Gray Van Kirk, LMFT
• William Van Sant

• Physician Assistant in Tigard, OR
• Providers in Tigard, OR by specialty
• Physician Assistant in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2013; 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.