Individual provider Active NPI

Kathryn Ann Stocking, PA-C

  • Physician Assistant
  • Portland, OR
National Provider Identifier
1558674333
Registry record updated Aug 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA201614 Issued in OR
Practice address
800 SW 13TH Ave
Portland, OR 97205-1999
Phone
(503) 221-0161
NPI assigned
Jul 21, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 7, 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 PA201614 OR Primary

Addresses

Primary practice location

800 SW 13TH Ave
Portland, OR 97205-1999

Mailing address

800 SW 13TH Ave
Portland, OR 97205-1999
Phone (503) 221-0161

Other identifiers 1

IdentifierTypeStateIssuer
500790237MedicaidOR

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20210429000895 OR Practitioner - Physician Assistant 6204245426 Reassigns benefits to 2 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services - Oregon CurrentSince Aug 1, 2024 Accepting new patients
The Portland Clinic Laboratory Current Accepting new patients
Uptown Providers PC Past Accepting new patients

Locations

9205 SW Barnes Rd
Portland, OR 97225
Phone (503) 216-1234

847 NE 19th Ave
Ste 300
Portland, OR 97232

800 SW 13th Ave
Portland, OR 97205
Phone (503) 221-0161

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": "1279670400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691366400000",
    "number": "1558674333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 SW 13TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972051999",
            "telephone_number": "503-221-0161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 SW 13TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972051999",
            "telephone_number": "503-221-0161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STOCKING",
        "first_name": "KATHRYN",
        "middle_name": "ANN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-07-21",
        "last_updated": "2023-08-07",
        "certification_date": "2023-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA201614",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500790237",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.