Carissa Ellis, DMSC, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

2725 SW Cedar Hills Blvd Ste 200
Beaverton, OR 97005-1435

Phone

(503) 352-6000

NPI assigned

May 22, 2020

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

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: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• Virginia Garcia Memorial Health Center

  • Federally Qualified Health Center (FQHC)
  • Cornelius, OR
  • NPI 1679528012
  Medicare reassignment NPD (past)
• Santiam Memorial Hospital

  • General Acute Care Hospital
  • Stayton, OR
  • NPI 1154302214
  Medicare reassignment
• Santiam Memorial Hospital

  • Rural Health Clinic/Center
  • Stayton, OR
  • NPI 1477909570
  NPD
• Santiam Memorial Hospital

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Stayton, OR
  • NPI 1801787171
  NPD

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

{
    "created_epoch": "1590105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742256000000",
    "number": "1518580646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6149",
            "city": "ALOHA",
            "state": "OR",
            "postal_code": "970070149",
            "telephone_number": "503-352-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2725 SW CEDAR HILLS BLVD STE 200",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970051435",
            "telephone_number": "503-352-6000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1401 N 10th Ave Ste 100",
            "address_purpose": "LOCATION",
            "city": "Stayton",
            "state": "OR",
            "postal_code": "973831486",
            "country_code": "US",
            "telephone_number": "503-769-6386",
            "fax_number": "503-769-5647",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "222 SE 8th Ave Ste 536",
            "address_purpose": "LOCATION",
            "city": "Hillsboro",
            "state": "OR",
            "postal_code": "971234218",
            "country_code": "US",
            "telephone_number": "503-352-7299",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "CARISSA",
        "credential": "DMSC, PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-05-22",
        "last_updated": "2025-03-18",
        "certification_date": "2025-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katelyn Brooke Elliott, RN, WHNP, CNM
• Matthew Z. Elliott, MA, LMFTI
• Melissa Ashley Elliott, BSN, RN
• Samuel Charles Elliott, CADC-I
• Alissa Lynn Ellis, CSWA
• Katherine Nicole Ellis
• Megan Ellis
• Elizabeth Ellisan, LPC
• Brnjamin Ellison
• Ebony Tatiana Ellison

• 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 Mar 18, 2025; 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.