NPIMap

Individual provider Active NPI

Elizabeth A Rupp, PA-C

  • Physician Assistant
  • Portland, OR
National Provider Identifier
1558638114
Registry record updated Jun 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA156615 Issued in OR
Practice address
4400 NE Halsey St Ste 102
Portland, OR 97213-1545
Phone
(503) 962-1000
NPI assigned
Nov 28, 2011
Last updated
Jun 20, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA156615 OR Primary

Addresses

Primary practice location

4400 NE Halsey St Ste 102
Portland, OR 97213-1545

Mailing address

PO Box 3158
Portland, OR 97208-3158
Phone (503) 215-6494

Other practice location 1

1111 NE 99th Ave
Suite 201
Portland, OR 97220-9428
Phone (503) 962-1000

Other identifiers 1

IdentifierTypeStateIssuer
500641646MedicaidOR

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address erupp113564@oc.providencedirect.org

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
I20120216000476 OR Practitioner - Physician Assistant 6204094568 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1321 NE 99TH Ave
Suite 200
Portland, OR 97220-9439
Phone (503) 215-4250

200 S Hazel Dell Way
Canby, OR 97013-7829
Phone (203) 263-9500

4400 NE Halsey St
Portland, OR 97213-1545

4805 NE Glisan St
Portland, OR 97213-2933

5050 NE Hoyt St
Suite 240
Portland, OR 97213-2981
Phone (503) 215-6480

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA156615ORMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services Oregon CurrentSince Jan 1, 2018 Accepting new patients
Providence Health & Services Oregon CurrentSince Jan 1, 2018 Accepting new patients
Providence Health & Services - Oregon CurrentSince Jan 30, 2012 Accepting new patients
Providence Health & Services Oregon CurrentSince Jan 30, 2012 Accepting new patients

Locations

200 S Hazel Dell Way
Canby, OR 97013
Phone (203) 263-9500

810 12th St
Hood River, OR 97031
Phone (541) 386-3911

1111 NE 99th Ave
Ste 201
Portland, OR 97220
Phone (503) 962-1020

1321 NE 99th Ave
Ste 200
Portland, OR 97220
Phone (503) 215-4250

4400 NE Halsey St
Ste 102
Portland, OR 97213
Phone (503) 216-0990

5050 NE Hoyt St
Ste 240
Portland, OR 97213
Phone (503) 215-6480

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 5

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": "1322438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687219200000",
    "number": "1558638114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3158",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083158",
            "telephone_number": "503-215-6494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4400 NE HALSEY ST STE 102",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972131545",
            "telephone_number": "503-962-1000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1111 NE 99th Ave",
            "address_2": "Suite 201",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972209428",
            "country_code": "US",
            "telephone_number": "503-962-1000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUPP",
        "first_name": "ELIZABETH",
        "middle_name": "A",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-11-28",
        "last_updated": "2023-06-20",
        "certification_date": "2023-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA156615",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500641646",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "erupp113564@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "1111 NE 99th Ave",
            "address_2": "Suite 201",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972209428",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.