NPIMap

Individual provider Active NPI

Bryan Lee Canwell, PA-C

  • Medical Physician Assistant
  • Pendleton, OR
National Provider Identifier
1598741860
Registry record updated Aug 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA157064 Issued in OR
Practice address
46314 Timine Way
Pendleton, OR 97801
Phone
(541) 966-9830
Fax
(541) 240-8751
NPI assigned
Dec 19, 2005
Last updated
Aug 12, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA157064 OR Primary

Addresses

Primary practice location

46314 Timine Way
Pendleton, OR 97801

Mailing address

P.O. Box 160
Pendleton, OR 97801
Phone (541) 966-9830

Other identifiers 3

IdentifierTypeStateIssuer
8944528OtherWAL&I-CRIME VICTIM
500650388MedicaidOR
8370884MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Joseph Lehigh Jensen III Past Accepting new patients
Joseph Lehigh Jensen III Past Accepting new patients
Assured Imaging Womens Wellness of Washington, LLC Past Accepting new patients
Central Washington Medical Associates Past Accepting new patients

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": "1134950400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597190400000",
    "number": "1598741860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 160",
            "city": "PENDLETON",
            "state": "OR",
            "postal_code": "97801",
            "telephone_number": "541-966-9830",
            "fax_number": "509-826-3653"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "46314 TIMINE WAY",
            "city": "PENDLETON",
            "state": "OR",
            "postal_code": "97801",
            "telephone_number": "541-966-9830",
            "fax_number": "541-240-8751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANWELL",
        "first_name": "BRYAN",
        "middle_name": "LEE",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-19",
        "last_updated": "2020-08-12",
        "certification_date": "2020-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OR",
            "license": "PA157064",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L&I-CRIME VICTIM",
            "identifier": "8944528",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500650388",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8370884",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pendleton, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.