NPIMap

Individual provider Active NPI

Debra Lauren Diaz, PA-C

  • Physician Assistant
  • Stanford, CA
National Provider Identifier
1417362096
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA189344 Issued in OR
Practice address
300 Pasteur Dr RM HC 133
Stanford, CA 94305-2200
Phone
(650) 725-5078
NPI assigned
Jun 23, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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 PA189344 OR Primary
Physician Assistant 363A00000X 54422 CA

Addresses

Primary practice location

300 Pasteur Dr RM HC 133
Stanford, CA 94305-2200

Mailing address

1650 NW Naito Pkwy
Ste 185
Portland, OR 97209-2535
Phone (503) 525-7694

Other practice location 1

2120 L St NW Ste 400
Washington, DC 20037-1538
Phone (202) 741-2911

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, WA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20181128000545 OR Practitioner - Physician Assistant 3678895331 Reassigns benefits to 3 organizations
I20200409003110 WA Practitioner - Physician Assistant 3678895331 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
George Washington University School of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Oregon Health and Science UniversityGroup PAC ID 1759328842, shared by 6 NPIs, 93 clinicians

Practice addresses (Care Compare)

3930 SE Division St
Portland, OR 97202-1643
Phone (503) 418-3900

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Oregon Health & Science University CurrentSince Jun 1, 2024 Accepting new patients
Legacy Good Samaritan Hospital and Medical Center CurrentSince Nov 1, 2018 Accepting new patients
University Professional Services CurrentSince Jun 1, 2024 Accepting new patients
Legacy Good Samaritan Hospital and Medical Center CurrentSince Nov 1, 2018 Accepting new patients
Oregon Health & Science University CurrentSince Jun 1, 2024 Accepting new patients
University Professional Services CurrentSince Jun 1, 2024 Accepting new patients

Locations

15700 SW Greystone Ct
Beaverton, OR 97006
Phone (503) 203-1000

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

1040 NW 22nd Ave
Ste 168
Portland, OR 97210
Phone (503) 413-7022

3181 SW Sam Jackson Park Rd
Portland, OR 97239
Phone (503) 494-5674

1130 NW 22nd Ave
Ste 400
Portland, OR 97210
Phone (503) 413-6555

3930 SE Division St
Portland, OR 97202
Phone (503) 418-3900

Interoperability endpoints

  • Direct secure messaging: ddiaz173795@direct.ohsu.edu

Organizations & group practices 9

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 2

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": "1403481600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1417362096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1650 NW NAITO PKWY",
            "address_2": "STE 185",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972092535",
            "telephone_number": "503-525-7694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 PASTEUR DR RM HC 133",
            "city": "STANFORD",
            "state": "CA",
            "postal_code": "943052200",
            "telephone_number": "650-725-5078"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2120 L St NW Ste 400",
            "address_purpose": "LOCATION",
            "city": "Washington",
            "state": "DC",
            "postal_code": "200371538",
            "country_code": "US",
            "telephone_number": "202-741-2911",
            "fax_number": "202-741-2921",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DIAZ",
        "first_name": "DEBRA",
        "middle_name": "LAUREN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-23",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA189344",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "54422",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stanford, CA

Sources for this page

Verify at the official NPI Registry.