Individual provider Active NPI

Angela T Young, PA-C

  • Physician Assistant
  • Salem, OR
National Provider Identifier
1578546743
Registry record updated Nov 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA00393 Issued in OR
Practice address
1100 22ND St SE
Salem, OR 97302-6558
Phone
(503) 967-6771
Fax
(503) 385-8421
NPI assigned
Nov 22, 2005
Last updated
Nov 29, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2022

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 PA00393 OR Primary

Addresses

Primary practice location

1100 22ND St SE
Salem, OR 97302-6558

Mailing address

1100 22ND St SE
Salem, OR 97302-6558
Phone (503) 967-6771

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
I20080318000315 OR Practitioner - Physician Assistant 4789760687 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
93.65 of 100Reported as group
Quality
86.8
Promoting interoperability
100
Improvement activities
40
Cost
86.36

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Salem Health CurrentSince Jan 1, 2020 Accepting new patients
Doctors Clinic LLP Past Accepting new patients

Locations

5050 Skyline Village Loop S
Salem, OR 97306
Phone (503) 291-2123

665 Winter St SE
Salem, OR 97301
Phone (503) 370-5634

875 Oak St SE
Ste 3010
Salem, OR 97301
Phone (503) 399-7520

875 Oak St SE
Ste C3010
Salem, OR 97301
Phone (503) 399-7520

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, 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": "1132617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669680000000",
    "number": "1578546743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 22ND ST SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973026558",
            "telephone_number": "503-967-6771",
            "fax_number": "503-385-8421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 22ND ST SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973026558",
            "telephone_number": "503-967-6771",
            "fax_number": "503-385-8421"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YOUNG",
        "first_name": "ANGELA",
        "middle_name": "T",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-22",
        "last_updated": "2022-11-29",
        "certification_date": "2022-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA00393",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, OR

Sources for this page

Verify at the official NPI Registry.