Individual provider Active NPI

Sara Lopez, PA

  • Physician Assistant
  • Indianapolis, IN
National Provider Identifier
1316602428
Registry record updated Jan 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA218030 Issued in OR
Practice address
1500 N Ritter Ave
Indianapolis, IN 46219-3027
Phone
(317) 355-5041
NPI assigned
Nov 3, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Physician Assistant 363A00000X PA218030 OR Primary

Addresses

Primary practice location

1500 N Ritter Ave
Indianapolis, IN 46219-3027

Mailing address

451 E Market St Apt 434
Indianapolis, IN 46204-2697
Phone (847) 915-9466

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, OR, WA3 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 3

Enrollment IDStateProvider typePAC IDDetails
I20220311002130 IN Practitioner - Physician Assistant 0143615005 Reassigns benefits to 1 organization
I20240213001159 OR Practitioner - Physician Assistant 0143615005 Reassigns benefits to 1 organization
I20240419003393 WA Practitioner - Physician Assistant 0143615005 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Legacy Clinics LLCGroup PAC ID 0244144004, 714 clinicians

Practice addresses (Care Compare)

1130 NW 22ND Ave
Suite 220
Portland, OR 97210-2969
Phone (503) 413-8988

21430 SW Langer Farms Pkwy
Suite 158
Sherwood, OR 97140-9141
Phone (971) 808-0655

22262 NE Glisan St
Gresham, OR 97030-8553
Phone (503) 489-2024

2850 SE Powell Valley Rd
Gresham, OR 97080-1494
Phone (503) 666-5050

2870 SW Cedar Hills Blvd
Beaverton, OR 97005-1354
Phone (503) 646-9222

3505 N Williams Ave
Portland, OR 97227-1437
Phone (503) 396-4950

4800 SW 76TH Ave
Portland, OR 97225-1804
Phone (971) 808-0665

9361 SE 82ND Ave
Happy Valley, OR 97086-3645
Phone (503) 457-4301

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.62 of 100Reported as apm
Quality
77.21
Promoting interoperability
99.06
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
97.51 of 100Reported as group
Quality
95.35
Improvement activities
40
Cost
78.59

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Legacy Clinics LLC CurrentSince Jan 29, 2024 Accepting new patients
Legacy Salmon Creek Hospital Past Accepting new patients

Locations

2870 SW Cedar Hills Blvd
Beaverton, OR 97005
Phone (503) 646-9222

22262 NE Glisan St
Gresham, OR 97030
Phone (503) 489-2024

2850 SE Powell Valley Rd
Gresham, OR 97080
Phone (503) 666-5050

3 Monroe Pkwy
Ste X
Lake Oswego, OR 97035
Phone (503) 679-3748

1900 McLoughlin Blvd
Ste 67
Oregon City, OR 97045

4800 SW 76th Ave
Portland, OR 97225
Phone (971) 808-0665

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

1919 NW Lovejoy St
Portland, OR 97209
Phone (503) 415-5600

21430 SW Langer Farms Pkwy
Ste 158
Sherwood, OR 97140
Phone (971) 808-0655

21900 Willamette Dr
Ste 209
West Linn, OR 97068
Phone (971) 274-0038

200 NE Mother Joseph Pl
Ste 410
Vancouver, WA 98664
Phone (503) 413-3580

305 SE Chkalov Dr
Ste 170
Vancouver, WA 98683
Phone (360) 799-3912

Organizations & group practices 3

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1635897600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706486400000",
    "number": "1316602428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "451 E MARKET ST APT 434",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462042697",
            "telephone_number": "847-915-9466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 N RITTER AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462193027",
            "telephone_number": "317-355-5041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOPEZ",
        "first_name": "SARA",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-11-03",
        "last_updated": "2024-01-29",
        "certification_date": "2024-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA218030",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.