Ivan A Wang, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA155662 Issued in OR

Practice address

5100 SW Macadam Ave Ste 200
Portland, OR 97239-3827

Phone

(971) 202-5500

Fax

(971) 202-5555

NPI assigned

Nov 15, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Specialty

Physician Assistant

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Marquis Clinical Services LLCGroup PAC ID 2860827821, 24 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Marquis Clinical Services LLC

  • Geriatric Medicine (Family Medicine) Physician
  • Milwaukie, OR
  • NPI 1710427810
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1321315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1518048000000",
    "number": "1598042764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2935 SW CEDAR HILLS BLVD",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970051342",
            "telephone_number": "503-352-6092",
            "fax_number": "503-352-6080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5100 SW MACADAM AVE STE 200",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972393827",
            "telephone_number": "971-202-5500",
            "fax_number": "971-202-5555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WANG",
        "first_name": "IVAN",
        "middle_name": "A",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-11-15",
        "last_updated": "2018-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA155662",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brianna Wang
• Connie Wang, MS, ATC/R
• Curtis Wang, DMD
• Eileen Wang
• Haomiao Wang, DMD, MD
• James Chung Huan Wang, ND, LAC
• James Yu Wang, MD
• Jasmin Wang, PHARMD, BCPS
• Jenny H Wang, D.O.
• Jerry Wang, OP

• Physician Assistant in Portland, OR
• Providers in Portland, OR by specialty
• Physician Assistant in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.