Carolina Alexandra Van Tulder, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA214771 Issued in OR

Practice address

10215 SW Hall Blvd
Tigard, OR 97223-8809

Phone

(503) 245-2415

Fax

(503) 244-5963

NPI assigned

Jul 16, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in SC, OR2 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

Specialty

Physician Assistant

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mountain West Derm - Blackhart PLLCGroup PAC ID 1153609813, 103 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ohsu Hospital and Clinics Hospital, Portland, OR, CCN 380009

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: cnick1@dapdx.emadirect.md

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.

• Mountain West Derm - Blackhart PLLC

  • Dermatology Physician
  • Bend, OR
  • NPI 1447764741
  Medicare reassignment Care Compare group NPD
• May River Dermatology

  • Medical Specialty Clinic/Center
  • Bluffton, SC
  • NPI 1770723512
  Medicare reassignment
• Bend Dermatology Clinic LLC

  • Dermatology Physician
  • Bend, OR
  • NPI 1649244393
  NPD
• Mountain West Derm-Blackhart, PLLC

  • Dermatology Physician
  • Tigard, OR
  • NPI 1316656994
  NPD
• Dermatology Associates,P.C.

  • Specialist
  • Tigard, OR
  • NPI 1851442461
  NPD (past)
• Mountain West Derm - Blackhart PLLC

  • Dermatology Physician
  • Roseburg, OR
  • NPI 1891467577
  NPD (past)
• Pinehurst Medical Clinic, Inc.

  • Clinical Medical Laboratory
  • Southern Pines, NC
  • NPI 1962509372
  NPD (past)

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

• Oregon Health & Science University

  • General Acute Care Hospital
  • Portland, OR
  • NPI 1609824010
  Care Compare affiliation

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

{
    "created_epoch": "1531699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744675200000",
    "number": "1417433145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10215 SW HALL BLVD",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972238809",
            "telephone_number": "503-245-2415",
            "fax_number": "503-244-5963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10215 SW HALL BLVD",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972238809",
            "telephone_number": "503-245-2415",
            "fax_number": "503-244-5963"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4004 Kruse Way Pl Ste 220",
            "address_purpose": "LOCATION",
            "city": "Lake Oswego",
            "state": "OR",
            "postal_code": "970352449",
            "country_code": "US",
            "telephone_number": "503-245-2415",
            "fax_number": "503-244-5963",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VAN TULDER",
        "first_name": "CAROLINA",
        "middle_name": "ALEXANDRA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-16",
        "last_updated": "2025-04-15",
        "certification_date": "2025-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA214771",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erin Jamie Van Dyke, PA-C
• Carol Anne Van Horn, R.PH. MBA
• Heather Van Houten, PA-C
• Linnea Gray Van Kirk, LMFT
• William Van Sant
• Lecia Marion Van Valkenburg
• Chantal Alyse Van Wely, MD
• Alexandra Domonique Van
• Davy Elizabeth Vandersommen, LMT
• Larissa Vanderwall

• Physician Assistant in Tigard, OR
• Providers in Tigard, OR by specialty
• Physician Assistant in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2025; 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.

Verify at the official NPI Registry.