NPIMap

Individual provider Active NPI

Michael Earl Yetter, PA-C

  • Medical Physician Assistant
  • Scappoose, OR
National Provider Identifier
1538196621
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
Practice address
33721 E Columbia Ave
Scappoose, OR 97056-3426
Phone
(503) 418-4222
NPI assigned
Jun 26, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X NU Primary

Addresses

Primary practice location

33721 E Columbia Ave
Scappoose, OR 97056-3426

Mailing address

4530 SE 39TH Ave
Portland, OR 97202-3120

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070514000367 OR Practitioner - Physician Assistant 4587761358 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

51377 SW Old Portland Rd
Scappoose, OR 97056-4023
Phone (503) 418-4222

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
University Professional Services CurrentSince Apr 3, 2020 Accepting new patients
University Professional Services CurrentSince Apr 3, 2020 Accepting new patients
Oregon Health & Science University CurrentSince Jul 3, 2006 Accepting new patients
Oregon Health & Science University CurrentSince Jul 3, 2006 Accepting new patients

Locations

15700 SW Greystone Ct
Beaverton, OR 97006
Phone (503) 203-1000

3930 SE Division St
Portland, OR 97202
Phone (503) 418-3900

33721 E Columbia Ave
Scappoose, OR 97056
Phone (503) 418-4222

51377 SW Old Portland Rd
Scappoose, OR 97056
Phone (503) 418-4222

Interoperability endpoints

  • Direct secure messaging: myetterpac23869@direct.ohsu.edu

Organizations & group practices 5

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 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1151280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1538196621",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4530 SE 39TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972023120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33721 E COLUMBIA AVE",
            "city": "SCAPPOOSE",
            "state": "OR",
            "postal_code": "970563426",
            "telephone_number": "503-418-4222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YETTER",
        "first_name": "MICHAEL",
        "middle_name": "EARL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Scappoose, OR

Sources for this page

Verify at the official NPI Registry.