Fardowsa Shariff Idris, PHYSICIAN ASSISTANT

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

202128 Issued in OR

Practice address

19255 SW 65TH Ave Ste 200
Tualatin, OR 97062-9712

Phone

(503) 828-1150

Fax

(503) 828-1160

NPI assigned

Oct 27, 2019

Last updated

Dec 11, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

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, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Sound Pain AllianceGroup PAC ID 0941565162, 43 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Valley Medical Center Hospital, Renton, WA, CCN 500088

Merit-based Incentive Payment System (MIPS)

Final score

71.86 of 100Reported as group

Quality

61.97

Promoting interoperability

67

Improvement activities

40

Cost

71.75

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Sound Pain Alliance

  dba Black Stone Health

  • Pain Medicine Physician
  • Bellingham, WA
  • NPI 1649776394
  Medicare reassignment Care Compare group NPD
• Sound Pain Alliance

  dba Black Stone Health

  • Pain Clinic/Center
  • Corvallis, OR
  • NPI 1437893286
  NPD
• Sound Pain Alliance

  dba Mt. Baker Surgery Center

  • Ambulatory Surgical Clinic/Center
  • Bellingham, WA
  • NPI 1457695116
  NPD
• Sound Pain Alliance

  dba Mt Baker Pain Clinic

  • Pain Clinic/Center
  • Burlington, WA
  • NPI 1538405709
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Public Hospital District 1 of King County

  dba Valley Medical Center

  • General Acute Care Hospital
  • Renton, WA
  • NPI 1649209230
  Care Compare affiliation
• Valley Medical Group-Renton

  • General Acute Care Hospital
  • Renton, WA
  • NPI 1619209574
  Care Compare affiliation

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

{
    "created_epoch": "1572134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607644800000",
    "number": "1609419225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19255 SW 65TH AVE STE 200",
            "city": "TUALATIN",
            "state": "OR",
            "postal_code": "970629712",
            "telephone_number": "503-828-1150",
            "fax_number": "503-828-1160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19255 SW 65TH AVE STE 200",
            "city": "TUALATIN",
            "state": "OR",
            "postal_code": "970629712",
            "telephone_number": "503-828-1150",
            "fax_number": "503-828-1160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IDRIS",
        "first_name": "FARDOWSA",
        "middle_name": "SHARIFF",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-10-27",
        "last_updated": "2020-12-11",
        "certification_date": "2020-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "202128",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Hund, DPT
• Ron Michelle Hunt, MASTER DEGREE
• Tyler Garrett Huntington
• Cynthia Ann Hutchison
• Won Bahng Hwee, PA-C
• Brenda Rebecca Ikwap, MD
• Nicole Gay Ingram, FNP
• Injury Specialists of Oregon PC
• Integrity Chiropractic & PT
• Internal Medicine Northwest,LLC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2020; 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.