Active NPI
Lisa Beattie, PA
- Physician Assistant
- Portland, OR
National Provider Identifier
1417060690
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- OR PA00658
- Practice address
- 1321 NE 99TH Ave
Suite 100
Portland, OR 97220-9437 - Phone
- (503) 215-9900
- NPI assigned
- Aug 15, 2006
- Sex
- Female
- Sole proprietor
- No
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 | OR PA00658 | OR | Primary |
Addresses
Primary practice location
1321 NE 99TH Ave
Suite 100
Portland, OR 97220-9437
Mailing address
PO Box 3158
Portland, OR 97208-3158
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 500605505 | Medicaid | OR |
Other names 1
- Lisa Althoff
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OR PA00658 | OR | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155600000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1415750400000",
"number": "1417060690",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3158",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972083158"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1321 NE 99TH AVE",
"address_2": "SUITE 100",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972209437",
"telephone_number": "503-215-9900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BEATTIE",
"first_name": "LISA",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-15",
"last_updated": "2014-11-12",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "OR",
"license": "OR PA00658",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "500605505",
"state": "OR"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "LISA",
"last_name": "ALTHOFF",
"code": "1",
"type": "Former Name"
}
]
}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 Nov 12, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.