Tiara F Packer, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA130018 Issued in OR

Practice address

3620 NW Samaritan Drive
Suite 202
Corvallis, OR 97330

Phone

(541) 768-4810

NPI assigned

Dec 18, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Firstcare Medical Foundation

  • Family Medicine Physician
  • Albany, OR
  • NPI 1740216498
  NPD (past)
• Good Samaritan Hospital Corvallis

  • Durable Medical Equipment & Medical Supplies
  • Corvallis, OR
  • NPI 1477851186
  NPD (past)
• Mark S. Robertson, P.C.

  • Otolaryngology/Facial Plastic Surgery Physician
  • Albany, OR
  • NPI 1205975588
  NPD (past)
• Monadnock Orthopaedic Associates

  • Specialist
  • Peterborough, NH
  • NPI 1992879936
  NPD (past)

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

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1285286400000",
    "number": "1447313010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3620 NW SAMARITAN DRIVE",
            "address_2": "SUITE 202",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "97330",
            "telephone_number": "541-768-4810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3620 NW SAMARITAN DRIVE",
            "address_2": "SUITE 202",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "97330",
            "telephone_number": "541-768-4810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PACKER",
        "first_name": "TIARA",
        "middle_name": "F",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-18",
        "last_updated": "2010-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NH",
            "license": "0614",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "OR",
            "license": "PA130018",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS  MOA",
            "identifier": "01Y005045NH03",
            "state": "NH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30334821",
            "state": "NH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS   MCH",
            "identifier": "01Y005045NH02",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pacific Hearing Services
• Pacific Medical, Inc.
• Pacific Pathways ABA, Inc.
• Lauren Paciulla, MS, RD
• Carmen Lee Pack
• Renee Padia
• Desirae Padilla
• Jariko N Padilla
• Rodney Padron Perez
• Angelina Marie Padua

• Surgical Physician Assistant in Corvallis, OR
• Providers in Corvallis, 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 Sep 24, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.