Individual provider Active NPI

Ainsley Grace Pate, PA-C

  • Physician Assistant
  • Portland, OR
National Provider Identifier
1568182756
Registry record updated Feb 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA222081 Issued in OR
Practice address
10803 SE Cherry Blossom Drive
Portland, OR 97216-3107
Phone
(503) 261-7200
Fax
(503) 261-7249
NPI assigned
Aug 30, 2022
Last updated
Feb 20, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA222081 OR Primary
Student in an Organized Health Care Education/Training Program 390200000X TX

Addresses

Primary practice location

10803 SE Cherry Blossom Drive
Portland, OR 97216-3107

Mailing address

10803 SE Cherry Blossom Drive
Portland, OR 97216-3107
Phone (503) 261-7200

Other identifiers 1

IdentifierTypeStateIssuer
500847986MedicaidOR

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
I20241112000172 OR Practitioner - Physician Assistant 6305370537 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
South Tabor Family PhysiciansGroup PAC ID 8921093048, 8 clinicians

Practice addresses (Care Compare)

Gresham, OR 97080
Phone (503) 261-7200

10803 SE Cherry Blossom Dr
Portland, OR 97216-3107

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Valeria Health, LLC CurrentSince Feb 23, 2025 Accepting new patients

Locations

10803 SE Cherry Blossom Dr
Portland, OR 97216
Phone (503) 261-7210

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1661817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740009600000",
    "number": "1568182756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10803 SE CHERRY BLOSSOM DRIVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972163107",
            "telephone_number": "503-261-7200",
            "fax_number": "503-261-7249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10803 SE CHERRY BLOSSOM DRIVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972163107",
            "telephone_number": "503-261-7200",
            "fax_number": "503-261-7249"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATE",
        "first_name": "AINSLEY",
        "middle_name": "GRACE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-30",
        "last_updated": "2025-02-20",
        "certification_date": "2022-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA222081",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "TX",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500847986",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.