Individual provider Active NPI

Amelia Sarah Evans, M.D.

  • Family Medicine Physician
  • Portland, OR
National Provider Identifier
1508092180
Registry record updated May 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD152661 Issued in OR
Practice address
3036 NE MLK Jr Blvd
Portland, OR 97212-3053
Phone
(503) 889-2500
NPI assigned
Jun 9, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 6, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A107979 CA
Family Medicine Physician 207Q00000X MD152661 OR Primary

Addresses

Primary practice location

3036 NE MLK Jr Blvd
Portland, OR 97212-3053

Mailing address

PO Box 8459
Portland, OR 97207-8459

Other practice location 1

800 N Main St
Santa Ana, CA 92701-3576
Phone (714) 456-7002

Other names 1

  • Amelia Sarah Edelman Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address aevans471280@oc.providencedirect.org

Medicare participation

Medicare enrollment files
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: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20180614001636 OR Practitioner - Family Practice 3274888235 Reassigns benefits to 1 organization
I20200224000923 WA Practitioner - Family Practice 3274888235 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Oregon Health Sciences University School of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Vital Care, PLLCGroup PAC ID 0143712414, 12 clinicians

Practice addresses (Care Compare)

101 NW 12TH Ave
Suite 107
Battle Ground, WA 98604-9141
Phone (360) 723-0528

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A107979CAMDFamily Medicine Physician
MD152661ORMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cascadia Health CurrentSince May 10, 2021 Accepting new patients
Cascadia Health Current Accepting new patients
Providence Health & Services - Washington Past Accepting new patients
Vital Care, PLLC Family Medicine Past Accepting new patients

Locations

707 NW Everett St
Portland, OR 97209
Phone (503) 222-4906

3036 NE Mlk Jr Blvd
Portland, OR 97212
Phone (503) 283-3763

Interoperability endpoints

  • Direct secure messaging: amelia.evans.1@27390.direct.athenahealth.com
  • Direct secure messaging: aevans342728@direct.ochin.org

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1244505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620259200000",
    "number": "1508092180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8459",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972078459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3036 NE MLK JR BLVD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972123053",
            "telephone_number": "503-889-2500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "800 N Main St",
            "address_purpose": "LOCATION",
            "city": "Santa Ana",
            "state": "CA",
            "postal_code": "927013576",
            "country_code": "US",
            "telephone_number": "714-456-7002",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EVANS",
        "first_name": "AMELIA",
        "middle_name": "SARAH",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-09",
        "last_updated": "2021-05-06",
        "certification_date": "2021-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A107979",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "MD152661",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "aevans471280@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "4816 NW Bethany Blvd",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972299254",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "AMELIA",
            "last_name": "EDELMAN",
            "middle_name": "SARAH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.