Individual provider Active NPI

Eric James Humphrey, PA-C

  • Physician Assistant
  • Tucson, AZ
National Provider Identifier
1356951891
Registry record updated Jun 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
11015 Issued in AZ
Practice address
6200 N la Cholla Blvd
Tucson, AZ 85741-3529
Phone
(520) 742-9000
NPI assigned
Aug 7, 2020
Last updated
Jun 6, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 6, 2025

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 1178659 OR
Physician Assistant 363A00000X 11015 AZ Primary

Addresses

Primary practice location

6200 N la Cholla Blvd
Tucson, AZ 85741-3529

Mailing address

13009 NE Highway 99 Ste 100
Vancouver, WA 98686-2307

Other practice location 1

13009 NE Highway 99 Ste 100
Vancouver, WA 98686-2307
Phone (360) 667-5840

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, AZ2 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 2

Enrollment IDStateProvider typePAC IDDetails
I20201203001874 OR Practitioner - Physician Assistant 8426469024 Reassigns benefits to 2 organizations
I20250630000231 AZ Practitioner - Physician Assistant 8426469024 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

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
96.85 of 100Reported as group
Quality
84.92
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1178659ORMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Legacy Clinics LLC CurrentSince Nov 6, 2020 Accepting new patients
The Oregon Clinic, PC Past Accepting new patients
Silverton Health Past Accepting new patients

Locations

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

2801 N Gantenbein Ave
Portland, OR 97227
Phone (503) 413-2200

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1596758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749168000000",
    "number": "1356951891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13009 NE HIGHWAY 99 STE 100",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986862307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6200 N LA CHOLLA BLVD",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857413529",
            "telephone_number": "520-742-9000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13009 NE Highway 99 Ste 100",
            "address_purpose": "LOCATION",
            "city": "Vancouver",
            "state": "WA",
            "postal_code": "986862307",
            "country_code": "US",
            "telephone_number": "360-667-5840",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HUMPHREY",
        "first_name": "ERIC",
        "middle_name": "JAMES",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-08-07",
        "last_updated": "2025-06-06",
        "certification_date": "2025-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "1178659",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "11015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucson, AZ

Sources for this page

Verify at the official NPI Registry.