Thao Van, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA169942 Issued in OR

Practice address

12345 SW Horizon Blvd Ste 57
Beaverton, OR 97007-9475

Phone

(503) 216-8820

NPI assigned

Aug 13, 2014

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 1

Electronic endpoints 8

Medicare fee-for-service enrollment

Enrolled in OR, WA2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tvan461377@oc.providencedirect.org

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.

• Kaiser Foundation Health Plan of the Northwest

  • General Practice Physician
  • Portland, OR
  • NPI 1184786527

  WA

  Medicare reassignment NPD
• Legacy Clinics LLC

  • Clinic/Center
  • Portland, OR
  • NPI 1902827272
  Medicare reassignment
• Kaiser Foundation Health Plan of the Northwest

  • General Practice Physician
  • Portland, OR
  • NPI 1306192455
  NPD
• Kaiser Foundation Health Plan of the Northwest

  • Clinic/Center
  • Hillsboro, OR
  • NPI 1942718622
  NPD

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

{
    "created_epoch": "1407888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634083200000",
    "number": "1467851600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12345 SW HORIZON BLVD STE 57",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970079475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12345 SW HORIZON BLVD STE 57",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970079475",
            "telephone_number": "503-216-8820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN",
        "first_name": "THAO",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-08-13",
        "last_updated": "2021-10-13",
        "certification_date": "2021-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA60719666",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA169942",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500677387",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tvan461377@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "12345 SW Horizon Blvd Ste 57",
            "city": "Beaverton",
            "state": "OR",
            "country_code": "US",
            "postal_code": "970079475",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tvan461377@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "14617 SE McLoughlin Blvd",
            "city": "Milwaukie",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972671416",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tvan461377@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "417 SW 117th Ave",
            "address_2": "Suite 200",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972255924",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tvan461377@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "4340 N Interstate Ave",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972173211",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tvan461377@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "5555 NE Elam Young Pkwy",
            "city": "Hillsboro",
            "state": "OR",
            "country_code": "US",
            "postal_code": "971246452",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tvan461377@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "7280 SW Beaverton Hillsdale Hwy",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972252008",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tvan461377@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "1905 SE 164th Ave",
            "city": "Vancouver",
            "state": "WA",
            "country_code": "US",
            "postal_code": "986838937",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tvan461377@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "9205 SW Barnes Rd",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972256603",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Abe Howard Van Hatch, MA
• Michelle Diane Van Horn
• Jillian Lucille Van Staaveren, DPT
• Taryn Weslie Van Vliet
• Kyle H. Van, D.D.S.
• Joseph Elias Vance, D.C.
• Vancouver DG LLC
• Margaret S. Vandenbark, M.D.
• Alisa Vanderzalm, MSW
• Meghan Siobhan Vandewettering, MD

• Physician Assistant in Beaverton, OR
• Providers in Beaverton, OR by specialty
• Physician Assistant in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2021; 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.