Individual provider Active NPI

Dwain Gavin McCall, PA-C

  • Physician Assistant
  • Vancouver, WA
National Provider Identifier
1578058194
Registry record updated Jun 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-13001 Issued in NC
Practice address
2211 NE 139TH St
Vancouver, WA 98686-2742
Phone
(360) 487-1000
NPI assigned
Jun 26, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2024

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 0010-13001 NC Primary

Addresses

Primary practice location

2211 NE 139TH St
Vancouver, WA 98686-2742

Mailing address

2817 Reilly St
Fort Bragg, NC 28310-7394
Phone (910) 632-2229

Other practice location 1

25050 SE Stark St
Gresham, OR 97030-3327
Phone (503) 674-1122

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, WA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20240610000453 OR Practitioner - Physician Assistant 2961877378 Reassigns benefits to 1 organization
I20240610002516 WA Practitioner - Physician Assistant 2961877378 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Northwest Acute Care Specialists PC CurrentSince Jul 1, 2024 Accepting new patients

Locations

24800 SE Stark St
Gresham, OR 97030
Phone (503) 413-8407

1015 NW 22nd Ave
Portland, OR 97210
Phone (503) 413-7582

2801 N Gantenbein Ave
Portland, OR 97227
Phone (503) 413-2200

19300 SW 65th Ave
Tualatin, OR 97062
Phone (503) 692-1212

2211 NE 139th St
Vancouver, WA 98686
Phone (360) 397-1985

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1529971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719619200000",
    "number": "1578058194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2817 REILLY ST",
            "city": "FORT BRAGG",
            "state": "NC",
            "postal_code": "283107394",
            "telephone_number": "910-632-2229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2211 NE 139TH ST",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986862742",
            "telephone_number": "360-487-1000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "25050 SE Stark St",
            "address_purpose": "LOCATION",
            "city": "Gresham",
            "state": "OR",
            "postal_code": "970303327",
            "country_code": "US",
            "telephone_number": "503-674-1122",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCCALL",
        "first_name": "DWAIN",
        "middle_name": "GAVIN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-26",
        "last_updated": "2024-06-29",
        "certification_date": "2024-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-13001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vancouver, WA

Sources for this page

Verify at the official NPI Registry.