Individual provider Active NPI

Douglas Paragone

  • Physician Assistant
  • Avon, CT
National Provider Identifier
1619356037
Registry record updated Dec 2, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
4228 Issued in CT
Practice address
385 W Main St
Avon, CT 06001-4357
Phone
(860) 777-1280
Fax
(860) 777-1276
NPI assigned
May 19, 2015
Last updated
Dec 2, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 1103 NH
Physician Assistant 363A00000X 4228 CT Primary

Addresses

Primary practice location

385 W Main St
Avon, CT 06001-4357

Mailing address

300 Derry Rd
Hudson, NH 03051-3023
Phone (603) 886-3979

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
I20200519001950 OR Practitioner - Physician Assistant 7416269717 Reassigns benefits to 1 organization
I20210111002487 WA Practitioner - Physician Assistant 7416269717 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

10100 SE Sunnyside Rd
Clackamas, OR 97015-8970
Phone (800) 813-2000

10180 SE Sunnyside Rd
Clackamas, OR 97015-8970
Phone (800) 813-2000

1700 NE 102ND Ave
Portland, OR 97220-3804
Phone (800) 813-2000

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4228CTMDEndodontist

Practice roles

OrganizationSpecialtyStatusNew patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Apr 27, 2020 Accepting new patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Sep 30, 2020 Accepting new patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Apr 27, 2020 Accepting new patients
Foundation Medical Partners Inc. Past Accepting new patients

Locations

10100 SE Sunnyside Rd
Clackamas, OR 97015
Phone (503) 571-2946

7201 N Interstate Ave
Portland, OR 97217
Phone (503) 240-4051

2400 Lancaster Dr NE
Salem, OR 97305
Phone (503) 361-5400

1230 7th Ave
Longview, WA 98632
Phone (360) 575-4801

7101 NE 137th Ave
Vancouver, WA 98682
Phone (360) 418-6000

Organizations & group practices 5

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": "1431993600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575244800000",
    "number": "1619356037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 DERRY RD",
            "city": "HUDSON",
            "state": "NH",
            "postal_code": "030513023",
            "telephone_number": "603-886-3979",
            "fax_number": "603-886-2898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "385 W MAIN ST",
            "city": "AVON",
            "state": "CT",
            "postal_code": "060014357",
            "telephone_number": "860-777-1280",
            "fax_number": "860-777-1276"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARAGONE",
        "first_name": "DOUGLAS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-05-19",
        "last_updated": "2019-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NH",
            "license": "1103",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CT",
            "license": "4228",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Avon, CT

Sources for this page

Verify at the official NPI Registry.