Elizabeth Petruska Knapp, MS, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

157071 Issued in OR

Practice address

3303 SW Bond Ave
Mail Code: Chh5E
Portland, OR 97239-4501

Phone

(503) 494-5421

NPI assigned

Jul 8, 2010

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

Other names 1

• Elizabeth Anne Petruska Former name

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

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.

• Paragon Health, P.C.

  • Plastic and Reconstructive Surgery Physician
  • Portage, MI
  • NPI 1629528765
  Medicare reassignment NPD
• Holley Medical Aesthetics PLLC

  • Plastic and Reconstructive Surgery Physician
  • Portage, MI
  • NPI 1801577671
  Medicare reassignment
• Paragon Health PC

  • Pediatrics Physician
  • Portage, MI
  • NPI 1427848845
  NPD

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

{
    "created_epoch": "1278547200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1338854400000",
    "number": "1427360346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3303 SW BOND AVE",
            "address_2": "MAIL CODE: CHH5E",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972394501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3303 SW BOND AVE",
            "address_2": "MAIL CODE: CHH5E",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972394501",
            "telephone_number": "503-494-5421"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KNAPP",
        "first_name": "ELIZABETH",
        "middle_name": "PETRUSKA",
        "credential": "MS, PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-07-08",
        "last_updated": "2012-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "OR",
            "license": "157071",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELIZABETH",
            "last_name": "PETRUSKA",
            "middle_name": "ANNE",
            "credential": "MS, PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• KN Drug LLC
• KN Drug LLC
• Jennifer Knapel
• Brandon Knapp
• Diane T Knapp, APRN, CRNA
• Heather Ruth Knapp, LMT, CA
• Jacquelyn Michelle Knapp, M.D.
• Joan J Knapp
• Khristina Elizabeth Knapp, R.N
• Madeline Louise Knapp

• Surgical Physician Assistant in Portland, OR
• Providers in Portland, OR by specialty
• Surgical Physician Assistant in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2012; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.