Active NPI
Ian Clemons, PA-C
- Physician Assistant
- Portland, OR
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA00692
- Practice address
- 3500 N Interstate Ave
Emergicenter
Portland, OR 97227-1196 - Phone
- (503) 331-6101
- NPI assigned
- Sep 20, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 | PA00692 | OR | Primary |
Addresses
Primary practice location
3500 N Interstate Ave
Emergicenter
Portland, OR 97227-1196
Mailing address
724 SE 27TH Ave
Portland, OR 97214-3009
Phone (503) 238-5097
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 1999
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1151 N Adair St
Cornelius, OR 97113-8900
Phone (503) 359-5564
2725 SW Cedar Hills Blvd
Suite 200
Beaverton, OR 97005-1435
Phone (503) 352-6000
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA00692 | OR | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Virginia Garcia Memorial Health Center | Current | Accepting new patients |
Locations
2725 SW Cedar Hills Blvd
Ste 200
Beaverton, OR 97005
Phone (503) 352-6000
1151 N Adair St
Cornelius, OR 97113
Phone (503) 352-8552
226 SE 8th Ave
Hillsboro, OR 97123
Phone (503) 601-7385
Interoperability endpoints
- iclemons312738@direct.ochin.org
Organizations & group practices 2
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.
-
- Federally Qualified Health Center (FQHC)
- McMinnville, OR
- NPI 1295997575
-
- Federally Qualified Health Center (FQHC)
- Cornelius, OR
- NPI 1679528012
Hospital & facility affiliations 12
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Psychiatric Hospital
- Hillsboro, OR
- NPI 1073817714
-
- General Acute Care Hospital
- Hillsboro, OR
- NPI 1275591984
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1336246479",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "724 SE 27TH AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972143009",
"telephone_number": "503-238-5097"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3500 N INTERSTATE AVE",
"address_2": "EMERGICENTER",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972271196",
"telephone_number": "503-331-6101"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLEMONS",
"first_name": "IAN",
"name_prefix": "Mr.",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "OR",
"license": "PA00692",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, 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.
- 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.