NPIMap

Individual provider Active NPI

Erin L Haines, PA-C

  • Medical Physician Assistant
  • Moro, OR
National Provider Identifier
1467651018
Registry record updated Apr 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA01244 Issued in OR
Practice address
110 Main St
Moro, OR 97039-3115
Phone
(541) 565-3325
Fax
(541) 565-3617
NPI assigned
Jul 13, 2007
Last updated
Apr 3, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA01244 OR Primary
Surgical Physician Assistant 363AS0400X PA01244 OR

Addresses

Primary practice location

110 Main St
Moro, OR 97039-3115

Mailing address

PO Box 186
Moro, OR 97039-0186
Phone (541) 565-3325

Other identifiers 1

IdentifierTypeStateIssuer
226813MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, WA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20071005000012 OR Practitioner - Physician Assistant 1153416102 Reassigns benefits to 1 organization
I20150917002404 WA Practitioner - Physician Assistant 1153416102 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sherman County Health DistrictGroup PAC ID 9335110238, 2 clinicians

Practice addresses (Care Compare)

110 Main St
Moro, OR 97039-3115
Phone (541) 565-3325

PO Box
Moro, OR 97039-0186

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA01244ORMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Public Hospital District No 2, Klickitat County, Washington CurrentSince Aug 1, 2015 Accepting new patients
Klickitat County Public Hospital District No 1 CurrentSince Jul 15, 2020 Accepting new patients
Public Hospital District No 2, Klickitat County Washington CurrentSince Aug 1, 2015 Accepting new patients
LMG LLC Past Accepting new patients

Locations

310 S Roosevelt St
Goldendale, WA 98620
Phone (509) 486-2151

Interoperability endpoints

  • Direct secure messaging: ehaines@kvhealthfm.gwaydirect.com
  • Direct secure messaging: erin.haines.1@33561.direct.athenahealth.com
  • FHIR API: https://fhir-myrecord.cerner.com/r4/ac6e817f-dc27-43e8-b886-6559f137e853/

Organizations & group practices 6

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.

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1184284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680480000000",
    "number": "1467651018",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 186",
            "city": "MORO",
            "state": "OR",
            "postal_code": "970390186",
            "telephone_number": "541-565-3325",
            "fax_number": "541-565-3617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 MAIN ST",
            "city": "MORO",
            "state": "OR",
            "postal_code": "970393115",
            "telephone_number": "541-565-3325",
            "fax_number": "541-565-3617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAINES",
        "first_name": "ERIN",
        "middle_name": "L",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-13",
        "last_updated": "2023-04-03",
        "certification_date": "2023-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OR",
            "license": "PA01244",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "OR",
            "license": "PA01244",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "226813",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Moro, OR

Sources for this page

Verify at the official NPI Registry.