Individual provider Active NPI

Whitney Headlee Marx, PA-C

  • Surgical Physician Assistant
  • Clackamas, OR
National Provider Identifier
1417735952
Registry record updated Nov 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA222532 Issued in OR
Practice address
10100 SE Sunnyside Rd
Clackamas, OR 97015-8970
Phone
(800) 813-2000
NPI assigned
Sep 18, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X PA222532 OR Primary

Addresses

Primary practice location

10100 SE Sunnyside Rd
Clackamas, OR 97015-8970

Mailing address

10100 SE Sunnyside Rd
Clackamas, OR 97015-8970
Phone (800) 813-2000

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241112002992 OR Practitioner - Physician Assistant 7719411800 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Beaverton Rehab & Specialty Care, LLC CurrentSince Oct 21, 2024 Accepting new patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Oct 21, 2024 Accepting new patients

Locations

10100 SE Sunnyside Rd
Clackamas, OR 97015
Phone (503) 571-2946

500 NE Multnomah St
Ste 100
Portland, OR 97232
Phone (503) 499-5200

2400 Lancaster Dr NE
Salem, OR 97305
Phone (503) 361-5400

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1694995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730505600000",
    "number": "1417735952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10100 SE SUNNYSIDE RD",
            "city": "CLACKAMAS",
            "state": "OR",
            "postal_code": "970158970",
            "telephone_number": "800-813-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10100 SE SUNNYSIDE RD",
            "city": "CLACKAMAS",
            "state": "OR",
            "postal_code": "970158970",
            "telephone_number": "800-813-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARX",
        "first_name": "WHITNEY",
        "middle_name": "HEADLEE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-09-18",
        "last_updated": "2024-11-02",
        "certification_date": "2024-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "OR",
            "license": "PA222532",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clackamas, OR

Sources for this page

Verify at the official NPI Registry.