Individual provider Active NPI

Erik Johnson-Saint Paine, OD

  • Optometrist
  • Portland, OR
National Provider Identifier
1457997231
Registry record updated Oct 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
AT4621 Issued in OR
Practice address
9555 SW Barnes Rd Ste 201
Portland, OR 97225-6654
Phone
(503) 227-2020
Fax
(503) 296-9934
NPI assigned
Nov 27, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X AT4621 OR Primary

Addresses

Primary practice location

9555 SW Barnes Rd Ste 201
Portland, OR 97225-6654

Mailing address

PO Box 22009
Portland, OR 97269-2009
Phone (503) 558-7372

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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220428001348 OR Practitioner - Optometry 4880081421 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
88.74 of 100Reported as group
Quality
85.23
Promoting interoperability
100
Improvement activities
40
Cost
77.25

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
AT4621ORMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Myoptic Optometry, LLC CurrentSince Apr 5, 2022 Accepting new patients

Locations

8046 SE 13th Ave
Portland, OR 97202
Phone (503) 420-8689

12 SE 28th Ave
Portland, OR 97214
Phone (503) 282-2020

3978 N Williams Ave
Portland, OR 97227
Phone (503) 493-7070

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1574812800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665619200000",
    "number": "1457997231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22009",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972692009",
            "telephone_number": "503-558-7372",
            "fax_number": "503-344-5140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9555 SW BARNES RD STE 201",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972256654",
            "telephone_number": "503-227-2020",
            "fax_number": "503-296-9934"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAINE",
        "first_name": "ERIK",
        "middle_name": "JOHNSON-SAINT",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-11-27",
        "last_updated": "2022-10-13",
        "certification_date": "2022-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "AT4621",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.